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Lymphopenia and DMTs for relapsing forms of MS: Considerations for the treating neurologist

PURPOSE OF REVIEW: To provide neurologists with an update on the proposed mechanisms of action (MOAs) of disease-modifying therapies (DMTs) for the treatment of relapsing MS, and their effect on peripheral blood leukocytes, in order to inform treatment decisions. RECENT FINDINGS: DMTs have vastly di...

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Autores principales: Fox, Edward J., Buckle, Guy J., Singer, Barry, Singh, Vibhuti, Boster, Aaron
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382377/
https://www.ncbi.nlm.nih.gov/pubmed/30859008
http://dx.doi.org/10.1212/CPJ.0000000000000567
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author Fox, Edward J.
Buckle, Guy J.
Singer, Barry
Singh, Vibhuti
Boster, Aaron
author_facet Fox, Edward J.
Buckle, Guy J.
Singer, Barry
Singh, Vibhuti
Boster, Aaron
author_sort Fox, Edward J.
collection PubMed
description PURPOSE OF REVIEW: To provide neurologists with an update on the proposed mechanisms of action (MOAs) of disease-modifying therapies (DMTs) for the treatment of relapsing MS, and their effect on peripheral blood leukocytes, in order to inform treatment decisions. RECENT FINDINGS: DMTs have vastly differing MOAs, including effects on peripheral blood leukocyte counts, particularly lymphocytes. The clinical implications of changes in lymphocyte counts need to be understood in the context of the underlying MOAs of each respective DMT, with treatment tailored to individual patient needs. SUMMARY: DMTs can alter lymphocyte counts, subsets, activation, and distribution, and thus can influence immune surveillance. Serial monitoring of total leukocytes and absolute lymphocyte counts (ALCs) is advisable in patients receiving DMTs. ALCs should be interpreted regarding expected immunologic changes and individual patient characteristics. Any decision to switch DMTs should consider these factors, along with drug efficacy, safety, and effect on quality of life.
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spelling pubmed-63823772019-03-11 Lymphopenia and DMTs for relapsing forms of MS: Considerations for the treating neurologist Fox, Edward J. Buckle, Guy J. Singer, Barry Singh, Vibhuti Boster, Aaron Neurol Clin Pract Review PURPOSE OF REVIEW: To provide neurologists with an update on the proposed mechanisms of action (MOAs) of disease-modifying therapies (DMTs) for the treatment of relapsing MS, and their effect on peripheral blood leukocytes, in order to inform treatment decisions. RECENT FINDINGS: DMTs have vastly differing MOAs, including effects on peripheral blood leukocyte counts, particularly lymphocytes. The clinical implications of changes in lymphocyte counts need to be understood in the context of the underlying MOAs of each respective DMT, with treatment tailored to individual patient needs. SUMMARY: DMTs can alter lymphocyte counts, subsets, activation, and distribution, and thus can influence immune surveillance. Serial monitoring of total leukocytes and absolute lymphocyte counts (ALCs) is advisable in patients receiving DMTs. ALCs should be interpreted regarding expected immunologic changes and individual patient characteristics. Any decision to switch DMTs should consider these factors, along with drug efficacy, safety, and effect on quality of life. Lippincott Williams & Wilkins 2019-02 /pmc/articles/PMC6382377/ /pubmed/30859008 http://dx.doi.org/10.1212/CPJ.0000000000000567 Text en Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Review
Fox, Edward J.
Buckle, Guy J.
Singer, Barry
Singh, Vibhuti
Boster, Aaron
Lymphopenia and DMTs for relapsing forms of MS: Considerations for the treating neurologist
title Lymphopenia and DMTs for relapsing forms of MS: Considerations for the treating neurologist
title_full Lymphopenia and DMTs for relapsing forms of MS: Considerations for the treating neurologist
title_fullStr Lymphopenia and DMTs for relapsing forms of MS: Considerations for the treating neurologist
title_full_unstemmed Lymphopenia and DMTs for relapsing forms of MS: Considerations for the treating neurologist
title_short Lymphopenia and DMTs for relapsing forms of MS: Considerations for the treating neurologist
title_sort lymphopenia and dmts for relapsing forms of ms: considerations for the treating neurologist
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382377/
https://www.ncbi.nlm.nih.gov/pubmed/30859008
http://dx.doi.org/10.1212/CPJ.0000000000000567
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