{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T16:57:03Z","timestamp":1785430623864,"version":"3.56.0"},"reference-count":15,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Can. J. Neurol. Sci."],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec id=\"S0317167126105368_as1\">\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The optimal time between the cessation of one disease-modifying therapy (DMT) and initiation of another in relapsing-remitting multiple sclerosis (RRMS) is incompletely understood. Lymphopenia, an adverse effect of dimethyl fumarate (DMF), may prompt a washout period prior to initiating an alternate DMT to allow absolute lymphocyte count (ALC) recovery. We hypothesized that during the DMF-DMT treatment interval, there would be disease activity, either by MRI or clinical relapses, and that lymphopenia might be a risk factor.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0317167126105368_as2\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A retrospective chart review was conducted, collecting data on demographics and disease activity (clinical relapse or MRI with new\/enlarged T2\/FLAIR or gadolinium-enhancing lesions in the brain or spinal cord). The DMF-DMT interval was defined as the time in years between stopping DMF and beginning a new DMT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0317167126105368_as3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Of 109 patients, 32.1% experienced disease activity during the DMF-DMT interval. ALC decreased significantly during DMF therapy but was not associated with subsequent disease activity in the DMF-DMT interval (HR 1.09 [0.62, 1.91],\n                      <jats:italic>p<\/jats:italic>\n                      = 0.77). A Kaplan\u2013Meier curve shows that the probability of experiencing disease activity was highest within the first year of DMF discontinuation, with the median time to first relapse after stopping DMF being 0.5 years.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0317167126105368_as4\">\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Disease activity was most likely to occur early after DMF cessation but was not significantly related to ALC. Our data suggest that initiating a new DMT within 6 months of DMF cessation may reduce relapse risk and lesion accumulation in RRMS patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/cjn.2026.10536","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T06:45:29Z","timestamp":1774421129000},"page":"1-7","source":"Crossref","is-referenced-by-count":1,"title":["Disease Activity Following Cessation of Dimethyl Fumarate in Patients with Relapsing-Remitting Multiple Sclerosis"],"prefix":"10.1017","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4404-6011","authenticated-orcid":false,"given":"Kasia","family":"Zubkow","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/010x8gc63","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Saskatchewan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Young","family":"Kim","sequence":"additional","affiliation":[{"name":"University of Saskatchewan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chantal","family":"Kahovec","sequence":"additional","affiliation":[{"name":"Saskatchewan Health Authority"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael C.","family":"Levin","sequence":"additional","affiliation":[{"name":"University of Saskatchewan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,3,25]]},"reference":[{"key":"S0317167126105368_ref5","doi-asserted-by":"publisher","DOI":"10.1177\/1352458516649037"},{"key":"S0317167126105368_ref14","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2016.0826"},{"key":"S0317167126105368_ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2020.102566"},{"key":"S0317167126105368_ref7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jneuroim.2021.577721"},{"key":"S0317167126105368_ref3","doi-asserted-by":"publisher","DOI":"10.1007\/s00109-019-01761-5"},{"key":"S0317167126105368_ref13","doi-asserted-by":"publisher","DOI":"10.1007\/s40120-019-00160-9"},{"key":"S0317167126105368_ref10","unstructured":"10. European Medicines Agency. Updated recommendations to minimise the risk of the rare brain infection PML with tecfidera. Published 2015. Accessed November 17, 2024. https:\/\/www.ema.europa.eu\/en\/documents\/press-release\/updated-recommendations-minimise-risk-rare-brain-infection-pml-tecfidera_en.pdf."},{"key":"S0317167126105368_ref15","doi-asserted-by":"publisher","DOI":"10.1177\/1756286419837809"},{"key":"S0317167126105368_ref11","doi-asserted-by":"publisher","DOI":"10.1177\/1352458517741191"},{"key":"S0317167126105368_ref4","doi-asserted-by":"publisher","DOI":"10.1177\/1352458520949158"},{"key":"S0317167126105368_ref2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2018.00005"},{"key":"S0317167126105368_ref8","unstructured":"8. Biogen Canada Inc. Product monograph including patient medication information, tecfidera dimethyl fumarate delayed-release capsules 120 mg and 240 mg, antineoplastic and immunomodulating agents. Accessed November 17, 2024. https:\/\/pdf.hres.ca\/dpd_pm\/00070736.PDF."},{"key":"S0317167126105368_ref1","doi-asserted-by":"publisher","DOI":"10.1177\/1756285614564152"},{"key":"S0317167126105368_ref12","doi-asserted-by":"publisher","DOI":"10.1111\/ane.12882"},{"key":"S0317167126105368_ref9","unstructured":"9. Biogen Inc. Tecfidera (Biogen Inc.): FDA package insert. Published March 2024. Accessed November 17, 2024. https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2024\/204063s031lbl.pdf."}],"container-title":["Canadian Journal of Neurological Sciences \/ Journal Canadien des Sciences Neurologiques"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0317167126105368","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T06:45:32Z","timestamp":1774421132000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0317167126105368\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,25]]},"references-count":15,"alternative-id":["S0317167126105368"],"URL":"https:\/\/doi.org\/10.1017\/cjn.2026.10536","relation":{},"ISSN":["0317-1671","2057-0155"],"issn-type":[{"value":"0317-1671","type":"print"},{"value":"2057-0155","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,25]]}}}