Lower lymphocyte counts and older age are associated with reduced multiple sclerosis disease activity during dimethyl fumarate treatment

Garbo, Riccardo; Lorenzut, Simone; Negro, Ilaria Del; Merlino, Giovanni; Gigli, Gian Luigi; Cargnelutti, Daniela; Valente, Mariarosaria

doi:10.1016/j.msard.2021.102781

Cited by 8 publications

(3 citation statements)

References 24 publications

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“…It is possible that a higher level of pretreatment ALC improves the potential antitumor ability of T cells and their hyper-reactive ability to immunotherapy (32). Similarly, lower ALC has been reported to be associated with reduced multiple sclerosis disease activity, which is consistent with our cognition of irAEs and autoimmune diseases (33). As a biomarker, ALC value is directly presented in the lab reports and needless to calculate compared to PLR or NLR, which is easier to be used by clinicians.…”

Section: Discussionsupporting

confidence: 82%

Correlations between peripheral blood biomarkers and clinical outcomes in advanced non-small cell lung cancer patients who received immunotherapy-based treatments

Shi¹,

Liu²,

Liu³

et al. 2021

Transl Lung Cancer Res

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Section: Discussionsupporting

confidence: 82%

Correlations between peripheral blood biomarkers and clinical outcomes in advanced non-small cell lung cancer patients who received immunotherapy-based treatments

Shi¹,

Liu²,

Liu³

et al. 2021

Transl Lung Cancer Res

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“…Lower baseline lymphocyte counts predicts on-treatment lymphopenia for fingolimod and dimethyl fumarate (DMF). Divergent publications suggest that lower absolute lymphocyte count correlates with greater DMF treatment efficacy [41,42], or report no correlation [43]. The efficacy of S1PR modulators, which result in lymphocyte redistribution but not destruction, was reported to not significantly correlate with total lymphocyte count, although the more lymphopenic group had a 34% lower annualised relapse rate in this study [44].…”

Section: Monitoring the Efficacy Of Disease-modifying Therapiescontrasting

confidence: 57%

MRI and laboratory monitoring of disease-modifying therapy efficacy and risks

Barnett

Reddel

2022

Current Opinion in Neurology

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Purpose of reviewIncreasingly, therapeutic strategy in multiple sclerosis (MS) is informed by imaging and laboratory biomarkers, in addition to traditional clinical factors. Here, we review aspects of monitoring the efficacy and risks of disease-modifying therapy (DMT) with both conventional and emerging MRI and laboratory measures.Recent findingsThe adoption of consensus-driven, stable MRI acquisition protocols and artificial intelligence-based, quantitative image analysis is heralding an era of precision monitoring of DMT efficacy. New MRI measures of compartmentalized inflammation, neuro-degeneration and repair complement traditional metrics but require validation before use in individual patients. Laboratory markers of brain cellular injury, such as neurofilament light, are robust outcomes in DMT efficacy trials; their use in clinical practice is being refined. DMT-specific laboratory monitoring for safety is critical and may include lymphocytes, immunoglobulins, autoimmunity surveillance, John Cunningham virus serology and COVID-19 vaccination seroresponse.SummaryA biomarker-enhanced monitoring strategy has immediate clinical application, with growing evidence of long-term reductions in disability accrual when both clinically symptomatic and asymptomatic inflammatory activity is fully suppressed; and amelioration of the risks associated with therapy. Emerging MRI and blood-based measures will also become important tools for monitoring agents that target the innate immune system and promote neuro-repair.

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“… 68 , 69 For this reason, it is important to monitor lymphocyte counts in patients receiving a therapy which may induce lymphopenia, such as DMF. 70 , 71 However, the degree of lymphopenia induced by DMF has not been associated with increased incidence of serious infections, 44 , 65 , 72 despite some case reports and database review findings of opportunistic infections. 69 , 73 – 80 Degree of lymphopenia has also been proposed by some to predict better responses to DMF, as a proxy measure for a less overactive immune response and pro-tolerogenic profile, 44 , 70 , 71 , 81 , 82 but most of the data have come from relatively small studies.…”

Section: Resultsmentioning

confidence: 99%

Clinical use of dimethyl fumarate in multiple sclerosis treatment: an update to include China, using a modified Delphi method

Gold

Barnett

Chan

et al. 2023

Ther Adv Neurol Disord

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Dimethyl fumarate (DMF) is a widely used oral disease-modifying therapy for multiple sclerosis (MS). Its efficacy and safety profiles are supported by over a decade of experience. Differences exist between Asia and Europe/United States in the prevalence and characteristics of MS; most data for DMF are derived from populations outside Asia. DMF was recently (2021) approved for use in China. The objectives of this review were to evaluate the evidence for DMF’s profile, to provide an update to healthcare providers on current knowledge surrounding its use and to assess the relevance of existing data to use in China. This study used a modified Delphi method based on the insights of a scientific Steering Committee (SC), with a structured literature review conducted to assess the data of DMF. The literature review covered all papers in English (from 01 January 2011 to 21 February 2022) that include ‘dimethyl fumarate’ and ‘multiple sclerosis’, and their MeSH terms, on PubMed, supplemented by EMBASE and Citeline searches. Papers were categorized by topic and assessed for relevance and quality, before being used to formulate statements summarizing the literature on each subject. SC members voted on/revised statements, requiring ⩾80% agreement and ⩽10% disagreement for inclusion. Statements not reaching this level were discussed further until agreement was reached or until there was agreement to remove the statement. A total of 1030 papers were retrieved and used to formulate the statements and evidence summaries considered by the SC members. A total of 45 statements were agreed by the SC members. The findings support the positive efficacy and safety profile of DMF in treating patients with MS. Limited Chinese patient data are an ongoing consideration; however, based on current evidence, the statements are considered applicable to both the global and Chinese populations. DMF is a valuable addition to address unmet MS treatment needs in China. Registration: Not applicable

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Lower lymphocyte counts and older age are associated with reduced multiple sclerosis disease activity during dimethyl fumarate treatment

Cited by 8 publications

References 24 publications

Correlations between peripheral blood biomarkers and clinical outcomes in advanced non-small cell lung cancer patients who received immunotherapy-based treatments

Correlations between peripheral blood biomarkers and clinical outcomes in advanced non-small cell lung cancer patients who received immunotherapy-based treatments

MRI and laboratory monitoring of disease-modifying therapy efficacy and risks

Clinical use of dimethyl fumarate in multiple sclerosis treatment: an update to include China, using a modified Delphi method

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