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KMID : 1130620220180060663
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Journal of Clinical Neurology
2022 Volume.18 No. 6 p.663 ~ p.670
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Safety and Temporal Pattern of the Lymphocyte Count During Fingolimod Therapy in Patients With Multiple Sclerosis: Real-World Korean Experience
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Huh So-Young
Kim Su-Hyun
Kim Ki-Hoon
Kwon Young-Nam
Kim Sung-Min
Kim Seung-Woo
Shin Ha-Young
Chung Yeon-Hak
Min Ju-Hong
So Jung-Min
Lim Young-Min
Kim Kwang-Kuk
Kim Nam-Hee
Nam Tai-Seung
Kang Sa-Yoon
Oh Jee-Young
Oh Seong-Il
Sohn Eun-Hee
Kim Ho-Jin
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Abstract
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Background and Purpose: Fingolimod (FTY) inhibits lymphocyte egress from lymphoid organs to cause lymphopenia, but the clinical implications of FTY-induced lymphopenia are not fully understood. We aimed to determine the frequency and severity of lymphopenia during FTY treatment among Korean patients with multiple sclerosis (MS), and its association with infections.
Methods: We retrospectively reviewed the medical records of patients with MS treated using FTY from 12 referral centers in South Korea between March 2013 and June 2021. Patients were classified according to their nadir absolute lymphocyte count (ALC) during treatment: grade 1, 800?999/μL; grade 2, 500?799/μL; grade 3, 200?499/μL; and grade 4, <200/μL.
Results: FTY treatment was administered to 69 patients with a median duration of 18 months (range=1?169 months), with 11 patients being treated for ≥7 years. During FTY treatment, mean ALCs were reduced after the first month (653.0±268.9/μL, mean±standard deviation) (p<0.0001) and remained low during treatment lasting up to 84 months. During follow-up, 41 (59.4%) and 7 (10.1%) patients developed grade-3 and grade-4 lymphopenia, respectively. No significant difference was found in age at FTY initiation, sex, baseline ALC, body mass index, or prior disease-modifying treatment between patients with and without grade-4 lymphopenia. Infections were observed in 11 (15.9%) patients, and the frequencies of patients with and without grade-4 lymphopenia were similar.
Conclusions: FTY treatment induced grade-4 lymphopenia in 10% of South Korean patients with MS, but did not appear to be associated with an increased infection risk.
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KEYWORD
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multiple sclerosis, fingolimod, lymphopenia
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