title: Unexpected exacerbations following initiation of disease-modifying drugs in neuromyelitis optica spectrum disorder: Which factor is responsible, anti-aquaporin 4 antibodies, B cells, Th1 cells, Th2 cells, Th17 cells, or others?
abstract: Some disease-modifying drugs for multiple sclerosis, which mainly act on T cells, are ineffective for neuromyelitis optica spectrum disorder and induce unexpected relapses. These include interferon beta, glatiramer acetate, fingolimod, natalizumab, and alemtuzumab. The cases reported here suggest that dimethyl fumarate, which reduces the number of Th1 and Th17 cells and induces IL-4-producing Th2 cells, is also unsuitable for neuromyelitis optica spectrum disorder, irrespective of anti-aquaporin 4 IgG serostatus. Although oral dimethyl fumarate with manageable adverse effects is easy to initiate in the early course of multiple sclerosis, special attention should be paid for atypical demyelinating cases.
authors.affiliation: Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Jun-Ichi
authors.initials: JI
authors.lastname: Kira
mesh_terms: D064420:Drug-Related Side Effects and Adverse Reactions / Q000276:immunology*; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects / Q000494:pharmacology*; D009471:Neuromyelitis Optica / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology*
chemical_list: D007155:Immunologic Factors
keywords: Multiple sclerosis; aquaporin 4; dimethyl fumarate; neuromyelitis optica spectrum disorder; relapse