Dimethyl fumarate has a risk of low blood white cell counts

Khatri BO, Garland J, Berger J, Kramer J, Sershon L, Olapo T, Sesing J, Dukic M, Rehn E The effect of dimethyl fumarate (Tecfidera™) on lymphocyte counts: A potential contributor to progressive multifocal leukoencephalopathy risk. Mult Scler Relat Disord. 2015; 4:377-9. doi: 10.1016/j.msard.2015.05.003. Epub 2015 May 14.

Dimethyl fumarate (Tecfidera™) is an effective therapy for relapsing forms of multiple sclerosis (MS). Our study suggests that this drug may have immunosuppressive properties evidenced by significant sustained reduction in CD8 lymphocyte counts and, to a lesser extent, CD4 lymphocyte counts. This observation is relevant in light of the recent case of progressive multifocal leukoencephalopathy in a patient receiving this drug.


It is true that DMF can cause a reduction of white blood cell counts and those people developing PML have had persistently reduced white blood cell counts. So monitoring blood lymphocytes for the presence of  leukopenia/leucopaenia will be part of this. 

The Neuros in the team have discussed puting out management protocols on the blog, for the benefit of other neuros out there, hopefully they will appear soon.

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