ArticleJournal of neurology2020
Risk factors for lymphopenia in patients with relapsing-remitting multiple sclerosis treated with dimethyl fumarate.
Article in Journal of neurology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 20 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
20 citing papers in PubMed, 41 citations in OpenAlex.
- Effectiveness and safety of cladribine in MS: Real-world experience from two tertiary centres.Multiple sclerosis (Houndmills, Basingstoke, England) · 2022Trial
- Dimethyl Fumarate Treatment in Patients With Primary Progressive Multiple Sclerosis: A Randomized, Controlled Trial.Neurology(R) neuroimmunology & neuroinflammation · 2021Trial
- Lymphocyte count polygenicity underlies dimethyl fumarate-associated lymphopenia in multiple sclerosis.Multiple sclerosis (Houndmills, Basingstoke, England) · 2026Article
- The combination of venetoclax with dimethyl fumarate synergistically induces apoptosis in AML cells by disrupting mitochondrial integrity through ROS accumulation.Cell death & disease · 2025Article
- New onset lymphopenia in patients with relapsing multiple sclerosis switching from long-standing dimethyl fumarate treatment to diroximel fumarate: A case series.Multiple sclerosis (Houndmills, Basingstoke, England) · 2024Article
- Lipoxin AbioRxiv : the preprint server for biology · 2024Article
- Frequency of Dimethyl Fumarate-Induced Lymphopenia among Omani Patients with Multiple Sclerosis.Sultan Qaboos University medical journal · 2024Article
- Prevalence of lymphopenia in the American population: Insights from demographic, BMI, and lifestyle factors.PloS one · 2024Article
- Effectiveness and safety profile of cladribine in an Italian real-life cohort of relapsing-remitting multiple sclerosis patients: a monocentric longitudinal observational study.Journal of neurology · 2023Observational
- Moving forward through the in silico modeling of multiple sclerosis: Treatment layer implementation and validation.Computational and structural biotechnology journal · 2023Article
- Predictors of Cladribine Effectiveness and Safety in Multiple Sclerosis: A Real-World, Multicenter, 2-Year Follow-Up Study.Neurology and therapy · 2022Article
- Coronavirus disease 2019 (Covid-19) vaccination recommendations in special populations and patients with existing comorbidities.Reviews in medical virology · 2022Review
- Administration of COVID-19 vaccines in immunocompromised patients.International immunopharmacology · 2021Review
- Interventions to Increase Leukocyte Testing during Treatment with Dimethyl Fumarate.International journal of environmental research and public health · 2021Article
- Effects of disease-modifying therapy on peripheral leukocytes in patients with multiple sclerosis.Journal of neurology · 2021Review
- Predictors of lymphocyte count recovery after dimethyl fumarate-induced lymphopenia in people with multiple sclerosis.Journal of neurology · 2021Article
- Preliminary Results of the FASM Study, an On-Going Italian Active Pharmacovigilance Project.Pharmaceuticals (Basel, Switzerland) · 2020Article
- Real-World Safety and Effectiveness of Dimethyl Fumarate in Black or African American Patients with Multiple Sclerosis: 3-Year Results from ESTEEM.Neurology and therapy · 2020Article
- Observational
- A retrospective analysis of changes in lymphocyte levels in patients with multiple sclerosis during and after Tecfidera® treatment.Multiple sclerosis journal - experimental, translational and clinicalArticle
Corrections and comments
- Erratum issued
Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo identify risk factors for DMF-induced lymphopenia and characterize its impact on T lymphocyte subsets in MS patients.
methodsWe performed a retrospective analysis of 194 RRMS patients treated with DMF at the Beth Israel Deaconess Medical Center (BIDMC) over a median of 17 months. We reviewed demographics, ethnic background, prior medication history, complete blood counts and T lymphocyte subsets. Possible lymphopenia risk factors examined included age, prior natalizumab exposure, vitamin D levels, and concomitant exposure to carbamazepine, opiates, tobacco, or steroids. Lymphopenia was defined as grade 1: absolute lymphocytes count (ALC) 800-999/μl; grade 2: ALC 500-799/μl; grade 3: ALC 200-499/μl; and grade 4: ALC < 200/μl.
resultsOf 194 DMF-treated patients, 73 (38%) developed lymphopenia and reached an ALC nadir after a median of 504 days (range 82-932). Risk of developing DMF-induced lymphopenia increased with BMI 25-30, older age, white ethnicity, non-smoking status, and lowest quartile baseline ALC. Prior exposure to natalizumab or concomitant steroid, opiates or carbamazepine/oxcarbamazepine use was not associated with lymphopenia. Compared to baseline levels, CD8 T cells were significantly more reduced than CD4 cells. CD8 counts were more commonly reduced with age or white ethnicity. Subjects with BMI 25-30 was associated with a higher risk of abnormal CD4 cell count reductions. In contrast, non-smokers were more likely to experience reductions in both CD4 and CD8 counts while on DMF.
conclusionsPatients with low baseline lymphocyte counts, with intermediate BMI, with white ethnicity, with advanced age, or with no tobacco use, had a significantly higher incidence of lymphopenia on DMF. Intermediate BMI or lowest quartile baseline ALC predicted low CD4 levels, while advanced age or white ethnicity predicted low CD8 levels from DMF exposure.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.