Skip to main content
Article
Three-year clinical outcomes of relapsing multiple sclerosis patients treated with dimethyl fumarate in a United States community health center.
Multiple sclerosis (Houndmills, Basingstoke, England)
  • Kyle E Smoot, Providence Multiple Sclerosis Center, Providence Health & Services, 9427 SW Barnes Road, Portland, OR 97225, USA; Providence Brain and Spine Institute, Providence Health & Services, 9135 SW Barnes Road, Suite 461, Portland, OR 97225, USA
  • Kateri Spinelli, Regional Research Department, Providence Health & Services, Portland, OR, USA
  • Tamela Stuchiner, Providence Multiple Sclerosis Center, Providence Brain and Spine Institute, Providence Health & Services, Portland, OR, USA
  • Lindsay Lucas, Providence Multiple Sclerosis Center, Providence Brain and Spine Institute, USA
  • Chiayi Chen, Providence Multiple Sclerosis Center, Providence Brain and Spine Institute, USA
  • Lois Grote, Providence Multiple Sclerosis Center, Providence Brain and Spine Institute, Providence Health & Services, Portland, OR, USA
  • Elizabeth Baraban, Providence Brain and Spine Institute
  • Kiren Kresa-Reahl, Providence Multiple Sclerosis Center, USA.
  • Stanley Cohan, Providence Multiple Sclerosis Center, USA.
Document Type
Article
Publication Date
6-1-2018
Keywords
  • Multiple sclerosis,
  • dimethyl fumarate,
  • disease progression,
  • lymphopenia,
  • tolerance
Disciplines
Abstract

BACKGROUND: Following approval of dimethyl fumarate (DMF), we established a registry of relapsing multiple sclerosis (RMS) patients taking DMF at our community MS center.

OBJECTIVE: To track DMF patients' tolerability, disease progression, and lymphopenia.

METHODS: Patients prescribed DMF for RMS from March 2013 to March 2016 were prospectively enrolled ( N = 412). Baseline data, clinical relapses, magnetic resonance imaging (MRI) activity, discontinuation, and lymphocyte counts were captured through chart review.

RESULTS: The mean age of patients starting DMF was 49.4 ± 12.0 years and 70% transitioned from a previous disease-modifying therapy (DMT). Of the patients, 38% discontinued DMF, 76% of whom discontinued due to side effects. Clinical relapse and MRI activity were low. Comparing patients who transitioned from interferon-β (IFN), glatiramer acetate (GA), or natalizumab (NTZ), patients previously on NTZ had higher rates of relapse than those previously on GA (annualized relapse rate p = 0.039, percent relapse p = 0.021). Grade III lymphopenia developed in 11% of patients. Lymphopenia was associated with older age ( p < 0.001) and longer disease duration ( p < 0.001).

CONCLUSION: Given the high rates of lymphopenia and discontinuation, it has become our clinical practice to more closely scrutinize older patients and those with a longer disease duration who are potential candidates for initiating DMF therapy.

Clinical Institute
Neurosciences (Brain & Spine)
Specialty
Neurosciences
Citation Information
Kyle E Smoot, Kateri Spinelli, Tamela Stuchiner, Lindsay Lucas, et al.. "Three-year clinical outcomes of relapsing multiple sclerosis patients treated with dimethyl fumarate in a United States community health center." Multiple sclerosis (Houndmills, Basingstoke, England) (2018)
Available at: http://works.bepress.com/kateri-spinelli/48/