PML in a Patient without Severe Lymphocytopenia Receiving Dimethyl Fumarate

Nieuwkamp, Dennis J.; Murk, Jean-Luc; Cremers, Charlotte H. P.; Killestein, Joep; Viveen, Marco C.; Hecke, Wim Van; Frijlink, Daphne W.; Wattjes, Mike P.; Oosten, B.W. van

doi:10.1056/nejmc1413724

Cited by 140 publications

(111 citation statements)

References 4 publications

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“…Two phase 3 studies have shown that dimethyl fumarate is effective at significantly reducing relapse rate and the number of new or enlarging T2-hyperintense lesions [109,110]. Though the safety profile was initially thought to be favorable, other than flushing and gastrointestinal disturbance, reports of PML in the setting of dimethyl fumarate have been released [111,112]. An open-label, randomized, activecontrolled study of dimethyl fumarate versus IFN-β1a (30 μg once weekly) in pediatric patients with MS (CONNECT) is currently recruiting.…”

Section: Dimethyl Fumaratementioning

confidence: 99%

Therapeutic Approach to the Management of Pediatric Demyelinating Disease: Multiple Sclerosis and Acute Disseminated Encephalomyelitis

Brenton

Banwell

2016

Neurotherapeutics

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Acquired pediatric demyelinating diseases manifest acutely with optic neuritis, transverse myelitis, acute disseminated encephalomyelitis, or with various other acute deficits in focal or polyfocal areas of the central nervous system. Patients may experience a monophasic illness (as in the case of acute disseminated encephalomyelitis) or one that may manifest as a chronic, relapsing disease [e.g., multiple sclerosis (MS)]. The diagnosis of pediatric MS and other demyelinating disorders of childhood has been facilitated by consensus statements regarding diagnostic definitions. Treatment of pediatric MS has been modeled after data obtained from clinical trials in adult-onset MS. There are now an increasing number of new therapeutic agents for MS, and many will be formally studied for use in pediatric patients. There are important efficacy and safety concerns regarding the use of these therapies in children and young adults. This review will discuss acute management as well as chronic immunotherapies in acquired pediatric demyelination.

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Section: Dimethyl Fumaratementioning

confidence: 99%

Therapeutic Approach to the Management of Pediatric Demyelinating Disease: Multiple Sclerosis and Acute Disseminated Encephalomyelitis

Brenton

Banwell

2016

Neurotherapeutics

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“…95,105 MRI based monitoring for early PML detection is appropriate not only for patients taking natalizumab, but also for other DMDs, including alemtuzumab, 106 rituximab 107 and dimethyl fumarate. [108][109][110] The value of MRI for treatment monitoring goes beyond PML detection. Other opportunistic infections leading to encephalitis (such as varicella zoster) can also develop in patients with MS, as has been shown during or after treat ment with fingolimod, a sphingosine 1 phosphate receptor modulator approved for MS treatment.…”

Section: Detection Of Adverse Effectsmentioning

confidence: 99%

MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis—establishing disease prognosis and monitoring patients

2015

Nat Rev Neurol

404

147

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“…One patient from an extension of one of the phase II studies developed PML after long-term low lymphocyte counts, suggesting that lymphocyte counts could be a risk marker [23]. A recent case of PML in DMF in RR-MS, however, apparently developed the infection in the absence of low lymphocyte counts, thus questioning their relevance for risk management [24]. These cases are certainly of concern but in light of the large number of treated patients worldwide, DMF is generally still viewed as a very useful and safe first-line DMT and has become one of the most commonly prescribed DMTs in RR-MS [25,26].…”

Section: Dimethyl Fumaratementioning

confidence: 99%

Advances in and Algorithms for the Treatment of Relapsing-Remitting Multiple Sclerosis

2016

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Treatment options in relapsing-remitting multiple sclerosis have increased considerably in recent years; currently, a dozen different preparations of diseasemodifying therapies are available and some more are expected to be marketed soon. For the treating neurologist this broad therapeutic repertoire not only greatly improves individualized management of the disease, but also makes choices more complex and difficult. A number of factors must be considered, including disease activity and severity, safety profile, and patient preference. We here discuss the currently existing options and suggest treatment algorithms for managing relapsing-remitting multiple sclerosis.

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PML in a Patient without Severe Lymphocytopenia Receiving Dimethyl Fumarate

Cited by 140 publications

References 4 publications

Therapeutic Approach to the Management of Pediatric Demyelinating Disease: Multiple Sclerosis and Acute Disseminated Encephalomyelitis

Therapeutic Approach to the Management of Pediatric Demyelinating Disease: Multiple Sclerosis and Acute Disseminated Encephalomyelitis

MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis—establishing disease prognosis and monitoring patients

Advances in and Algorithms for the Treatment of Relapsing-Remitting Multiple Sclerosis

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