好色先生

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Abstract Details

Dimethyl Fumarate Dose Reduction in Lymphopenic Relapsing Remitting Multiple Sclerosis Patients: Clinical and MRI Outcomes
Multiple Sclerosis
P4 - Poster Session 4 (5:30 PM-6:30 PM)
15-013

Utilize clinical measures to determine the outcome of dimethyl fumarate (DMF) dose reduction.
Dimethyl fumarate is a first-line therapy for treatment of relapsing and remitting multiple sclerosis (RRMS). DMF 240 mg twice daily can result in lymphopenia. Dose reduction may lessen the degree of lymphopenia, but clinical effectiveness of reduced dose DMF is unknown.
We performed a retrospective review of RRMS patients on oral DMF therapy from the University of Utah and Veterans Affairs Salt Lake City Health Care System databases (March 2013 to September 2018). Patients on reduced dose DMF due to lymphopenia were identified and included in this analysis
Of 425 patients identified through chart review, total of 92 patients had lymphopenia (<0.91 k/μL). Of the 92 patients, average age was 55.1 (range of 28–79), and 56.5% were female (n=52). In 31 patients, DMF dose was reduced to 240 mg once daily (or less) for an average duration of 31 months or longer (range 28-52). During the observational period, average lymphocyte counts increased from 0.55±0.13 k/μL (range of 0.3–0.9 k/μL) to 0.82±0.17 k/μL (range of 0.5–1.2 k/μL). Prior to dose reduction the average EDSS assessment score was 4.14±1.9 (range of 1.5-7) and average time 25-foot walk (T25FW) was 7.1±3.6 seconds (range of 4.0-19.0 sec). Thirty-One months after dose reduction average EDSS score were 4.21±1.8 (range of 1.5-7) and average T25FW was 7.2±3.7 seconds (range of 4.0-21.0 sec). During the observational period, none of the patient experienced a clinical relapse.  Only six new lesions over 31 months in 31 patients were observed on clinical brain and spinal cord MRI scan (n=87).

Our findings indicate that reduced dose DMF can result in improvement in lymphopenia as well as continued clinical stability over an intermediate time period. Consistent MRI monitoring for disease activity may be particularly important in these patients.
Authors/Disclosures
Ka-Ho Wong (U of U Neurology Clinic)
PRESENTER 		The institution of Mr. Wong has received research support from The Sumaira Foundation . The institution of Mr. Wong has received research support from The Siegel Rare Neuroimmune Association.
Rae E. Bacharach, DO (Penn State University, Milton S Hershey Medical Center) Dr. Bacharach has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for 好色先生.
Erica Marini No disclosure on file
No disclosure on file
Stacey Clardy, MD, PhD, FAAN (University of Utah) Dr. Clardy has received personal compensation for serving as an employee of Veterans Health Administration (VHA). Dr. Clardy has received personal compensation for serving as an employee of University of Utah Health. Dr. Clardy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AstraZeneca/Alexion. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen/Horizon. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Arialys. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Kyverna. Dr. Clardy has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology/AAN Publications. The institution of Dr. Clardy has received research support from NIH/NINDS. The institution of Dr. Clardy has received research support from SRNA. The institution of Dr. Clardy has received research support from Alexion/AstraZeneca. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving as a AAN Summer Meeting CoDirector Travel and Lodging with AAN. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving as a Grand Rounds Travel/Lodging/Honoraria with U of Iowa, Miami, Stanford, Barrow, Beaumont Health, CCF, Emory, Penn State, Mayo Clinic, Walter Reed.
Melissa M. Cortez, DO (University of Utah Neurology) The institution of Dr. Cortez has received research support from NIH NINDS. The institution of Dr. Cortez has received research support from Dysautonomia International. Dr. Cortez has received personal compensation in the range of $500-$4,999 for serving as a Content Expert, Reviewer, DSMB with NIH RECOVER project.
L D. DeWitt, MD (Department of Neurology, CNC) Dr. DeWitt has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen.
John E. Greenlee, MD, FAAN (University of Utah) Dr. Greenlee has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Medlink. Dr. Greenlee has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Zeigler Cohen Roche. Dr. Greenlee has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Sommers Schwartz PC. Dr. Greenlee has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for St Francis Hospital. Dr. Greenlee has received publishing royalties from a publication relating to health care. Dr. Greenlee has received publishing royalties from a publication relating to health care.
Julia Klein, NP (University of Utah School of Medicine) An immediate family member of Ms. Klein has received personal compensation for serving as an employee of Amgen. An immediate family member of Ms. Klein has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Amgen.
M. M. Paz Soldan, MD, PhD (Mayo Clinic) Dr. Paz Soldan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG Therapeutics. The institution of Dr. Paz Soldan has received research support from National Institutes of Health. The institution of Dr. Paz Soldan has received research support from National Multiple Sclerosis Society. The institution of Dr. Paz Soldan has received research support from Western Institute for Biomedical Research. The institution of Dr. Paz Soldan has received research support from Biogen. The institution of Dr. Paz Soldan has received research support from Novartis. The institution of Dr. Paz Soldan has received research support from Clene Nanomedicine.
John D. Steffens, MD Dr. Steffens has nothing to disclose.
John W. Rose, MD, FAAN (Imaging and Neurosciences Center) The institution of Dr. Rose has received research support from National Multiple Sclerosis Society. The institution of Dr. Rose has received research support from Guthy Jackson Charitable Foundation. The institution of Dr. Rose has received research support from NIH . The institution of Dr. Rose has received research support from VA. The institution of Dr. Rose has received research support from Biogen. The institution of Dr. Rose has received research support from Friends of MS. Dr. Rose has received intellectual property interests from a discovery or technology relating to health care.