Blood glucose levels modulate dimethyl fumerate-associated neutropenia in MS patients
Author(s): ,
M.D. Goldman
S. Gadani
School of Medicine, University of Virginia
M.-W. Sohn
Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA
O. Stuve
Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX; VA North Texas Health Care System/ Dallas VA Medical Center, Dallas, VA, United States
ECTRIMS Online Library. Goldman M. Oct 12, 2018; 229033; P1193
Myla Denise Goldman
Myla Denise Goldman
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Abstract: P1193

Type: Poster Sessions

Abstract Category: Therapy - Immunomodulation/Immunosuppression

Introduction: Dimethyl Fumerate (DM) is associated with a reduction in lymphocytic numbers in peripheral blood. This effect is very varied in magnitude between patients. DMF disruption of neutrophil function has been reported in animal models, but not explored in humans. Co-morbid conditions, such as glucose intolerance, are of increased interest and focus in MS. Diabetes is associated with alterations in leukocytes, often measured by the neutrophil-lymphcyte ratio (NLR). We hypothesized that blood-glucose (BG) levels would correspond to NLR in DMF treated patients.
Objective/Aims: 1) Explore the relationship between absolute lymphocyte and neutraphil counts and NLR with serum BG in one center cohort (UVA). 2) To confirm any identified associations from Aim1 in second center cohort (DaVA).
Methods: Ninety-seven DMF treated patients were identified at 2-US clinics. The first center population (UVA) was used to test hypothesis and the second center population (DaVA) was used to confirm findings. Data was collected through chart review at respective clinics. Analyses were completed on de-identified data sets (MDG).
Results: Ninety-nine subjects (65-UVA, 34-DaVA) had requisite data available for inclusion. The two populations were well matched for age and serum-BG, lymphocytes & NLR. DaVA population had lower on-treated neutrophil counts compared with UVA, mean±sd: 3.5±1.3 vs 4.4±1.6, p=0.006). Average and minimum absolute neutrophil count are significantly correlated to average BG blood in the DaVA population [rho=0.42 ( p=0.02) and rho=0.356 (p=0.04), respectively], who had higher BG values and lower ANC compared to the UVA cohort. In univarient regression model maximum measured blood glucose predict both, lowest absolute neutrophil count (F-value 4.82, p=0.03), average neutrophils (F-value 5.71, p=0.019) and NRL (F-value 3.77, p=0.05).
Conclusions: We believe this is the first report of DMF-associated neutropenia in MS patients. This pilot work supports that basal BG values may interplay with the immune system and impact leukocyte response to in DMF-treated patients. Additional analysis will be presented.
Disclosure: MDG: Consulting fees: ADAMAS, EMD Serono, Sanofi, Novartis Pharmaceuticals, Teva Neuroscience. Research support: Biogen IDEC, National MS Society, NIH, Novartis Pharmaceuticals,PCORI.
SG: nothing to disclose
MWS: nothing to disclose
OS: Consulting fees: EMD Serono. Personal compensation in an editorial capacity for Therapeutic Advances in Neurological Disorders. Research support:Teva Pharmaceuticals, Opexa Therapeutics and Sanofi-Genzyme.

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