#MSCOVID19: Lymphopaenia

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I am giving an MS Academy masterclass webinar today on the topic of lymphopaenia and its relevance to managing MS during the COVID-19 pandemic. My talk goes back to basics and tries to explain how the normal range and WHO grading system came about and includes the important topic of immunosenescence.

You are welcome to sign-up for the webinar. If you can’t manage to log-on to the live webinar it will be recorded and put on-line after the event.

The following are my slides for today’s webinar:

CoI: multiple

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

9 comments

  • I think the difficulty in attempting to attend these webinars is obviously tied to multiplicity of Zoom presentations and so if you can archive them and one wants to review them later that would be most helpful.

    Lymphopenia and opportunistic infections for instance, are related but it is not a 1:1 issue. Sometimes the #s look goood and PML pops up. Or, RTX and RA might throw up PML but no PML when RTX is used in MS !!! Intriguing? Yes!

    Or, TNF alpha blockers worsen MS but are good for RA or IBD !!

  • You mention on your slides that the infection risk on Fingolimod is cumulative and consequently increases the longer Fingolimod is taken. I knew this about Natalizumab but it is the first time in my 8.5 years on Fingolimod that I have read or heard this. Do you have any numbers on this and/or links to publicly available research? I would be very grateful!

    • It happens with all immunosuppressive therapies; the longer you are on the more likely you are to develop a malignancy or get an opportunistic infection.

      For example, the PML and cryptococcal infection signal emerged at around year 4 and the lymphoma risk at about year 6. You can look at what gets added to the SmPC with each update.

      • I also didn’t realize that the risk for secondary malignancies increased with years an immunosuppressive DMT is used. Not something my neurologist ever explained to me.
        Will be saving this post as a reference! 🙏 thanks

  • It happens with all immunosuppressive therapies; the longer you are on the more likely you are to develop a malignancy or get an opportunistic infection.

    For example, the PML and cryptococcal infection signal emerged at around year 4 and the lymphoma risk at about year 6. You can look at what gets added to the SmPC with each update.

    • To prove your point that longer duration of Fingolimod therapy is associated with increased rates of infection, why doesn’t any company that has drug(s) approved for use in MS (by the FDA or the EMA) put out their post-marketing data in the open in the name of transparency and let the ‘chips fall where they may’ ? How come there are zero laws governing this and why don’t lawmakers get this right ? Is this because the drug companies have deep pockets ? I guess that is the answer.

      • Even if the do the study they put it as an abstract in an MS meeting and never publish it as you know the data will get worse with time. This information should be collated say for seasonaly flu vaccines.

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