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- Title
High CD4 :CD8 ratios with herpes zoster infections in patients with multiple sclerosis on dimethyl fumarate.
- Authors
Balshi, Alexandra; Saart, Emma; Pandeya, Sarbesh; Dempsey, John; Baber, Ursela; Sloane, Jacob A
- Abstract
Background: Dimethyl fumarate (DMF) depletes CD8 and CD4 T cells, and cases of herpes zoster (HZ) in patients with multiple sclerosis (MS) on DMF have been documented. Objectives: To evaluate lymphocyte subsets in patients with MS who developed HZ on DMF (Tecfidera) compared to matched controls who did not develop HZ. Methods: We used linear mixed-effects models to test for differences in white blood cell count, lymphocyte percentage, absolute lymphocyte count, CD3 percentage, absolute CD3 count, CD4 percentage, absolute CD4 count, CD8 percentage, absolute CD8 count, and CD4 :CD8 ratio over time in HZ and non-HZ groups. Results: Eighteen patients developed HZ while on DMF. The linear mixed-effects model for CD4 :CD8 ratio showed a significant difference between the HZ and non-HZ groups (p = 0.033). CD4 :CD8 ratio decreased over time in the HZ group and increased over time in the non-HZ group. Conclusion: Patients with MS who develop HZ while on DMF have high CD4 :CD8 ratios, suggesting an imbalance of CD4 and CD8 cells that may put a patient at risk for developing HZ while on DMF. This result emphasizes the need for lymphocyte subset monitoring (including CD4 :CD8 ratios) on DMF, as well as vaccination prior to DMF initiation.
- Subjects
DIMETHYL fumarate; HERPES zoster; LEUKOCYTE count; MULTIPLE sclerosis; LYMPHOCYTE subsets
- Publication
Multiple Sclerosis Journal, 2023, Vol 29, Issue 11/12, p1465
- ISSN
1352-4585
- Publication type
Academic Journal
- DOI
10.1177/13524585231189641