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Much remains to be elucidated about the biological effects of<jats:styled-content style=\"fixed-case\">FAE<\/jats:styled-content>s on lymphocytes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the influence of long\u2010term<jats:styled-content style=\"fixed-case\">FAE<\/jats:styled-content>(Fumaderm<jats:sup>\u00ae<\/jats:sup>) treatment on peripheral blood<jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4<jats:sup>+<\/jats:sup>and<jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>8<jats:sup>+<\/jats:sup>T cells,<jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>19<jats:sup>+<\/jats:sup>B cells and<jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>56<jats:sup>+<\/jats:sup>natural killer (<jats:styled-content style=\"fixed-case\">NK<\/jats:styled-content>) cells in psoriasis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this single\u2010centre retrospective observational subcohort study, we obtained leucocyte and lymphocyte subset counts before initiating<jats:styled-content style=\"fixed-case\">FAE<\/jats:styled-content>therapy in 371 psoriasis patients (mean age, 47.8\u00a0years; 63.3% males) and monitored them during treatment (mean treatment duration, 2.9\u00a0years). Multiparametric flow cytometry was used for immunophenotyping.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">FAE<\/jats:styled-content>s significantly reduced the numbers of<jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4<jats:sup>+<\/jats:sup>T,<jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>8<jats:sup>+<\/jats:sup>T,<jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>19<jats:sup>+<\/jats:sup>B and<jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>56<jats:sup>+<\/jats:sup><jats:styled-content style=\"fixed-case\">NK<\/jats:styled-content>cells. Among lymphocyte subsets, the mean percentage reduction from baseline was always highest for<jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>8<jats:sup>+<\/jats:sup>T cells, with a peak of 55.7% after 2\u00a0years of therapy. The risk of T\u2010cell lymphopenia increased significantly with the age of the psoriasis patients at the time that<jats:styled-content style=\"fixed-case\">FAE<\/jats:styled-content>therapy was initiated. It was significantly decreased for the combination therapy with methotrexate and folic acid (vitamin B9) supplementation. Supporting evidence was found suggesting that T\u2010cell lymphopenia enhances the effectiveness of<jats:styled-content style=\"fixed-case\">FAE<\/jats:styled-content>therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Monitoring distinct T\u2010cell subsets rather than just absolute lymphocyte counts may provide more meaningful insights into both the<jats:styled-content style=\"fixed-case\">FAE<\/jats:styled-content>treatment safety and efficacy. We therefore suggest optimizing pharmacovigilance by additionally monitoring<jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>4<jats:sup>+<\/jats:sup>and<jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>8<jats:sup>+<\/jats:sup>T\u2010cell counts at regular intervals, especially in patients of middle to older age. Thus, further prospective studies are needed to establish evidence\u2010based recommendations to guide dermatologists in the management of psoriasis patients who are taking<jats:styled-content style=\"fixed-case\">FAE<\/jats:styled-content>s and who develop low absolute T\u2010cell counts.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jdv.15448","type":"journal-article","created":{"date-parts":[[2019,1,25]],"date-time":"2019-01-25T07:59:31Z","timestamp":1548403171000},"page":"893-905","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Fumaric acid ester\u2010induced T\u2010cell lymphopenia in the real\u2010life treatment of psoriasis"],"prefix":"10.1111","volume":"33","author":[{"given":"H.","family":"Dickel","sequence":"first","affiliation":[{"name":"Department of Dermatology, Venereology and Allergology Ruhr University Bochum Bochum 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