Severe multiple sclerosis reactivation during prolonged lymphopenia after dimethyl fumarate discontinuation.

Autor: Zecca C; Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland.; Neuroimmunology and Neuromuscular Diseases Unit, IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy., Antozzi CG; Neuroimmunology and Neuromuscular Diseases Unit, IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy., Torri Clerici V; Neuroimmunology and Neuromuscular Diseases Unit, IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy., Ferrazzini M; Studio medico neurologico, Locarno, Switzerland., Mantegazza RE; Neuroimmunology and Neuromuscular Diseases Unit, IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy., Rossi S; Neuroimmunology and Neuromuscular Diseases Unit, IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy., Gobbi C; Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland.
Jazyk: angličtina
Zdroj: Acta neurologica Scandinavica [Acta Neurol Scand] 2018 Jun; Vol. 137 (6), pp. 623-625. Date of Electronic Publication: 2017 Dec 03.
DOI: 10.1111/ane.12882
Abstrakt: Background: Delayed-release dimethyl fumarate (DMF) treatment can be associated with reduced lymphocyte and leucocyte counts, which might persist after DMF discontinuation.
Case Presentation: We report the case of a patient with severe disease reactivation despite prolonged lymphopenia after DMF discontinuation. We describe the frequency and impact of prolonged lymphopenia after DMF discontinuation at two tertiary MS centres. A 36-year-old female patient with multiple sclerosis was switched to DMF after 14 years of treatment with interferon beta-1a. DMF was suspended after 4 months because of persistent lymphopenia for 3 months. Six months later, the patient had a severe relapse with multiple enhancing brain lesions at MRI although lymphopenia was still persistent. Haematological assessment excluded other causes of lymphopenia, which was evaluated as a probable iatrogenic complication of DMF. The patient was treated with i.v. methylprednisolone 1 gr daily for 3 days with clinical recovery.
Conclusions: Prolonged lymphopenia after DMT discontinuation does not protect against disease reactivation. Starting a new immune therapy should be balanced against the option of a "wait and see." A different immunotherapeutic strategy such as an anti-B therapeutic approach could be considered.
(© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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