Lymphopenia in treatment-naive relapsing multiple sclerosis

Lim, Zhi Wei; Elwood, Elliot; Naveed, Hammad; Galea, Ian

doi:10.1212/nxi.0000000000000275

Cited by 10 publications

(9 citation statements)

References 6 publications

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“…The synthetic polymer glatiramer acetate (GA) does not affect absolute lymphocyte counts (ALCs). 53 Instead, GA appears to promote anti-inflammatory cytokine shifts in CD4 + and CD8 + T cells, restores Tregs, and decreases both memory B and T cells. 20,54 Consequently, GA is infrequently associated with leukopenia, and when it does occur it is generally mild in nature.…”

Section: Glatiramer Acetatementioning

confidence: 99%

Lymphopenia and DMTs for relapsing forms of MS

Fox

Buckle

et al. 2019

Neur Clin Pract

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Purpose of reviewTo provide neurologists with an update on the proposed mechanisms of action (MOAs) of disease-modifying therapies (DMTs) for the treatment of relapsing MS, and their effect on peripheral blood leukocytes, in order to inform treatment decisions.Recent findingsDMTs have vastly differing MOAs, including effects on peripheral blood leukocyte counts, particularly lymphocytes. The clinical implications of changes in lymphocyte counts need to be understood in the context of the underlying MOAs of each respective DMT, with treatment tailored to individual patient needs.SummaryDMTs can alter lymphocyte counts, subsets, activation, and distribution, and thus can influence immune surveillance. Serial monitoring of total leukocytes and absolute lymphocyte counts (ALCs) is advisable in patients receiving DMTs. ALCs should be interpreted regarding expected immunologic changes and individual patient characteristics. Any decision to switch DMTs should consider these factors, along with drug efficacy, safety, and effect on quality of life.

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Section: Glatiramer Acetatementioning

confidence: 99%

Lymphopenia and DMTs for relapsing forms of MS

Fox

Buckle

et al. 2019

Neur Clin Pract

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“…First, we were unable to account for the effects of medication use and other clinical characteristics (age of MS onset, disease duration) on hematological profile due to a lack of data for these variables. It has been reported that MS treatments can affect hematological values [ 31 , 32 , 33 ], so our observed associations may correlate with treatments and not necessarily disease onset. Observed associations may also be due to changes as MS progresses, rather than onset.…”

Section: Discussionmentioning

confidence: 80%

The Impact of Multiple Sclerosis Disease Status and Subtype on Hematological Profile

Miller

Beales

Montierth

et al. 2021

IJERPH

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Multiple sclerosis (MS) is an immune-mediated, demyelinating disease of the central nervous system. In this study, an MS cohort and healthy controls were stratified into Caucasian and African American groups. Patient hematological profiles—composed of complete blood count (CBC) and complete metabolic panel (CMP) test values—were analyzed to identify differences between MS cases and controls and between patients with different MS subtypes. Additionally, random forest models were used to determine the aggregate utility of common hematological tests in determining MS disease status and subtype. The most significant and relevant results were increased bilirubin and creatinine in MS cases. The random forest models achieved some success in differentiating between MS cases and controls (AUC values: 0.725 and 0.710, respectively) but were not successful in differentiating between subtypes. However, larger samples that adjust for possible confounding variables, such as treatment status, may reveal the value of these tests in differentiating between MS subtypes.

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“…In addition, MS patients may already have lymphopenia prior to immunomodulatory treatment. In one study, lymphopenia was detected in 10% of treatment-naïve MS patients, which was no different from values in a matched cohort of healthy controls [23]. Further analysis revealed no association between pre-treatment lymphocyte count and patient variables, including age, sex, MS category, autoimmune comorbidities, disease duration, time since the last relapse, and last relapse severity.…”

Section: Definition Of Lymphocytopenia (Lymphopenia)mentioning

confidence: 90%

“…In the general population, infection risk increases linearly below an absolute lymphocyte count of approximately 1.7 GPt/L. Even at a mild lymphocyte decrease (grade 1), there is a 26% higher risk of infection, at grade 2, there is a 44% increase in risk, and with grade 3, it increases rapidly (+76%) [23]. In addition, MS patients may already have lymphopenia prior to immunomodulatory treatment.…”

Section: Definition Of Lymphocytopenia (Lymphopenia)mentioning

confidence: 99%

Lymphocyte Counts and Multiple Sclerosis Therapeutics: Between Mechanisms of Action and Treatment-Limiting Side Effects

Fischer

Proschmann

Akgün

et al. 2021

Cells

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Although the detailed pathogenesis of multiple sclerosis (MS) is not completely understood, a broad range of disease-modifying therapies (DMTs) are available. A common side effect of nearly every MS therapeutic agent is lymphopenia, which can be both beneficial and, in some cases, treatment-limiting. A sound knowledge of the underlying mechanism of action of the selected agent is required in order to understand treatment-associated changes in white blood cell counts, as well as monitoring consequences. This review is a comprehensive summary of the currently available DMTs with regard to their effects on lymphocyte count. In the first part, we describe important general information about the role of lymphocytes in the course of MS and the essentials of lymphopenic states. In the second part, we introduce the different DMTs according to their underlying mechanism of action, summarizing recommendations for lymphocyte monitoring and definitions of lymphocyte thresholds for different therapeutic regimens.

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Lymphopenia in treatment-naive relapsing multiple sclerosis

Cited by 10 publications

References 6 publications

Lymphopenia and DMTs for relapsing forms of MS

Lymphopenia and DMTs for relapsing forms of MS

The Impact of Multiple Sclerosis Disease Status and Subtype on Hematological Profile

Lymphocyte Counts and Multiple Sclerosis Therapeutics: Between Mechanisms of Action and Treatment-Limiting Side Effects

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