{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T02:15:34Z","timestamp":1779934534092,"version":"3.53.1"},"reference-count":21,"publisher":"SAGE Publications","issue":"11-12","license":[{"start":{"date-parts":[[2023,8,12]],"date-time":"2023-08-12T00:00:00Z","timestamp":1691798400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Mult Scler"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Dimethyl fumarate (DMF) depletes CD8+ and CD4+ T cells, and cases of herpes zoster (HZ) in patients with multiple sclerosis (MS) on DMF have been documented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To evaluate lymphocyte subsets in patients with MS who developed HZ on DMF (Tecfidera) compared to matched controls who did not develop HZ.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We used linear mixed-effects models to test for differences in white blood cell count, lymphocyte percentage, absolute lymphocyte count, CD3+ percentage, absolute CD3+ count, CD4+ percentage, absolute CD4+ count, CD8+ percentage, absolute CD8+ count, and CD4+:CD8+ ratio over time in HZ and non-HZ groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Eighteen patients developed HZ while on DMF. The linear mixed-effects model for CD4+:CD8+ ratio showed a significant difference between the HZ and non-HZ groups ( p = 0.033). CD4+:CD8+ ratio decreased over time in the HZ group and increased over time in the non-HZ group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Patients with MS who develop HZ while on DMF have high CD4+:CD8+ ratios, suggesting an imbalance of CD4+ and CD8+ cells that may put a patient at risk for developing HZ while on DMF. This result emphasizes the need for lymphocyte subset monitoring (including CD4+:CD8+ ratios) on DMF, as well as vaccination prior to DMF initiation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13524585231189641","type":"journal-article","created":{"date-parts":[[2023,8,12]],"date-time":"2023-08-12T08:05:16Z","timestamp":1691827516000},"page":"1465-1470","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":14,"title":["High CD4+:CD8+ ratios with herpes zoster infections in patients with multiple sclerosis on dimethyl fumarate"],"prefix":"10.1177","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3202-6921","authenticated-orcid":false,"given":"Alexandra","family":"Balshi","sequence":"first","affiliation":[{"name":"Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Saart","sequence":"additional","affiliation":[{"name":"Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA"},{"name":"Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell, Manhasset, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarbesh","family":"Pandeya","sequence":"additional","affiliation":[{"name":"Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Dempsey","sequence":"additional","affiliation":[{"name":"Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ursela","family":"Baber","sequence":"additional","affiliation":[{"name":"Department 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USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,8,12]]},"reference":[{"key":"bibr1-13524585231189641","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.10364"},{"key":"bibr2-13524585231189641","doi-asserted-by":"publisher","DOI":"10.4065\/82.11.1341"},{"key":"bibr3-13524585231189641","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268816003174"},{"key":"bibr4-13524585231189641","doi-asserted-by":"publisher","DOI":"10.1111\/ced.14650"},{"key":"bibr5-13524585231189641","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2014.3065"},{"key":"bibr6-13524585231189641","doi-asserted-by":"publisher","DOI":"10.1177\/1352458515576984"},{"key":"bibr7-13524585231189641","doi-asserted-by":"publisher","DOI":"10.1007\/82_2010_31"},{"key":"bibr8-13524585231189641","doi-asserted-by":"publisher","DOI":"10.1212\/NXI.0000000000000076"},{"key":"bibr9-13524585231189641","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1114287"},{"key":"bibr10-13524585231189641","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1206328"},{"key":"bibr11-13524585231189641","doi-asserted-by":"publisher","DOI":"10.1177\/13524585211037909"},{"key":"bibr12-13524585231189641","doi-asserted-by":"publisher","DOI":"10.1002\/ana.24471"},{"key":"bibr13-13524585231189641","doi-asserted-by":"publisher","DOI":"10.1212\/NXI.0000000000000203"},{"key":"bibr14-13524585231189641","doi-asserted-by":"publisher","DOI":"10.1212\/NXI.0000000000001017"},{"key":"bibr15-13524585231189641","doi-asserted-by":"publisher","DOI":"10.1371\/journal.ppat.1007650"},{"key":"bibr16-13524585231189641","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.1302596"},{"key":"bibr17-13524585231189641","doi-asserted-by":"publisher","DOI":"10.1111\/sji.13125"},{"key":"bibr18-13524585231189641","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-020-04897-2"},{"key":"bibr19-13524585231189641","doi-asserted-by":"publisher","DOI":"10.1016\/j.jneuroim.2017.05.006"},{"key":"bibr20-13524585231189641","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000007262"},{"key":"bibr21-13524585231189641","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7103a2"}],"container-title":["Multiple 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