YangMao-Draayer, Neurologist, University of Michiganmaodraay@umich.edu
Qi Wu, Guangmei Mao, Steven K. Lundy
Submitted June 08, 2016
We thank Drs. Longbrake and Cross for the interest in our article. [1] The goal of our ongoing study is to investigate prospectively long-term changes to subtypes of B cells following dimethyl fumarate (DMF) treatment in patients with multiple sclerosis (MS). Our small case series featured differences in B cell subsets within individual patients with relapsing-remitting MS (RRMS) before and after treatment. [1] Although we reported statistically significant increases to total B cells at baseline in the patients compared to age and gender-matched controls (Figure 1B), we did not intend to imply that the results in this small cohort refute publications showing no significant differences in the proportion of circulating B cells in RRMS patients. [2,3]
We noted and discussed that 5 out of the 13 patients had steroid treatments close to baseline as well as other previous treatments (Table 1). [1] Furthermore, we showed that DMF treatment reduced total circulating B cells in individual patients with RRMS, but that it had an opposite effect on regulatory B cell subsets long after steroid use was discontinued. We stand by these results while advocating for larger studies that can assess influences of previous treatments on responses to DMF.
1. Lundy SK, Wu Q, Wang Q, et al. Dimethyl fumarate treatment of relapsing-remitting multiple sclerosis influences B-cell subsets. Neurol Neuroimmunol Neuroinflamm 2016;3:e211.
2. de Andres C, Tejera-Alhambra M, Alonso B, et al. New regulatory CD19(+)CD25(+) B-cell subset in clinically isolated syndrome and multiple sclerosis relapse. Changes after glucocorticoids. J Neuroimmunol 2014;270:37-44.
3. Krystyna MS, Jacek T, Sebastian R, et al. Changes in circulating dendritic cells and B-cells in patients with multiple sclerosis relapse during corticosteroid therapy. J Neuroimmunol 2009;207:107-110.
For disclosures, please contact the editorial office at nnnjournal@neurology.org.
We noted and discussed that 5 out of the 13 patients had steroid treatments close to baseline as well as other previous treatments (Table 1). [1] Furthermore, we showed that DMF treatment reduced total circulating B cells in individual patients with RRMS, but that it had an opposite effect on regulatory B cell subsets long after steroid use was discontinued. We stand by these results while advocating for larger studies that can assess influences of previous treatments on responses to DMF.
1. Lundy SK, Wu Q, Wang Q, et al. Dimethyl fumarate treatment of relapsing-remitting multiple sclerosis influences B-cell subsets. Neurol Neuroimmunol Neuroinflamm 2016;3:e211.
2. de Andres C, Tejera-Alhambra M, Alonso B, et al. New regulatory CD19(+)CD25(+) B-cell subset in clinically isolated syndrome and multiple sclerosis relapse. Changes after glucocorticoids. J Neuroimmunol 2014;270:37-44.
3. Krystyna MS, Jacek T, Sebastian R, et al. Changes in circulating dendritic cells and B-cells in patients with multiple sclerosis relapse during corticosteroid therapy. J Neuroimmunol 2009;207:107-110.
For disclosures, please contact the editorial office at nnnjournal@neurology.org.