MS Speaks
Multiple Sclerosis => TREATMENTS => Topic started by: agate on May 16, 2017, 12:21:07 pm
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Presented at the annual AAN conference in Boston, April 2017:
Retrospective review on the prevalence of lymphopenia in patients aged 55 years and over taking oral disease-modifying therapies for multiple sclerosis
Clover Youn1, Mary Ann Picone2, Frederick Foley4, Jeffrey Portnoy4, Laura Schiraldi5, Karen Blitz-Shabbir3
1
Internal Medicine/Neurology, Mount Sinai Beth Israel, 2
Neurology, Holy Name Medical Center, 3
Holy Name Medical Center, 4 Yeshiva University, 5 Touro College of Osteopathic Medicine
Objective:
We investigated the prevalence of lymphopenia in MS patients 55 years and older on oral DMTs through chart review.
Background:
Oral disease-modifying therapies (DMTs) are approved for treatment of multiple sclerosis (MS) as alternatives to injectable or infusion therapies. However, these therapies have their own set of adverse effects, including lymphopenia.
Past clinical trials for oral DMTs (teriflunomide, fingolimod, dimethyl fumarate) have
examined patients 18-55 years old. However, there is a dearth of data investigating oral DMTs in the older MS population.
Design/Methods:
We evaluated absolute lymphocyte count (ALC) in patients who took oral DMTs from 9/2010 to 4/2016, aged 55 years or older at the start of treatment (N=113). We defined lymphopenia as ALC <1000 cells/microL, but also analyzed relative decreases in ALC. We compared ALC prior to treatment with ALC at <6 months as well as >6 months duration of treatment to investigate incidence of prolonged lymphopenia. Patients missing records (N=31) and younger than 55 years old were excluded.
Results:
A series of one-tailed Wilcoxon signed-rank tests were performed too. We noted overall significant reduction in ALC of patients taking any of the three DMTs: Z = −4.78, p < .001,r = −.37. At duration <6 months, significant reduction was observed in patients taking each DMT. At duration >6 mos, significant reduction was
observed in patients taking fingolimod (Z = −2.80, p = .003, r = −.63) and dimethyl fumarate (Z = −3.92, p <.001, r = −.53). A non-significant reduction was observed in patients taking teriflunomide (Z = −1.63, p =.051, r = −.19).
Conclusions:
We observed a significant relative decrease in ALC in patients on each oral DMT. The persistence of significant relative lymphopenia in the fingolimod and dimethyl fumarate groups at duration >6 months may suggest a more prolonged course of lymphopenia compared to younger populations.