Low lymphocyte counts and multiple sclerosis

Question:
Is there reason for concern when after stopping Techfidera, in August, because of low absolute lymphocyte count, my count has only rebounded to 560 at the highest. (It started in the 200). And I started Aubagio in Dec. and my count dropped back to 480.

Answer:
It is well known that absolute lymphocyte counts can remain low for a long time in patients who were previously taking Tecfidera. In my experience this is related to the duration of lymphopenia (low lymphocyte count) before stopping the tecfidera. This may actually help in the treatment of your MS since lymphocytes of different types are involved in the immune process damaging the nervous system in MS. On the other hand this may also may you more susceptible to certain infections or even malignancies in the future. Although Aubagio does not significantly lower lymphocyte counts, it may make it more difficult for lymphocyte counts to be restored to normal levels. Depending on your risk factors for relapses and disease progression, you doctor may want to consider stopping Aubagio until your lymphocyte counts are above 900.

Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego