This paper argues that if you look at blood cell counts it may help about look at disease activity. This view is perhaps abit controversial as there have been many studies looking at immune cell subsets circulating in the blood after a DMT and have not been able to find an association with disease activity….If it is so simple this study can be repeated and shown to be beneficial in a prospective study i.e. making prediction form these events not looking backwards and then making an explanation for observed disease activity. I am sure there will be changes but it is knowing where to look and importantly how often you look. This is where many studies fall down because you do not look often enough. Whole blood cell counts are frequently done and this is not in depth enough as the real effect is diluted making harder to spot.
Looking at white blood cell counts can tell you if your drug is working. If the drug is a depleting drug the white cell count should drop if the drug inhibits migration of cells in the brain, like natalizumab then the white cells should go up. They do in most cases but because you are looking at whole lymphocytes it is not as easy to spot, but if you look at B cell numbers which is more seldomly done (a) because it costs more and is more time consuming and (b) Because people thing T cells are the cells to watch..then it is easier to see. The data is out there you just need to look.
Moustafa NM, Alahmed H, Mahgoub O, Alanazi B, AlShammary A, Mohamed RA. Peripheral blood inflammatory cell ratios derived from complete blood count as predictors of multiple sclerosis disease activity and severity. Egypt J Immunol. 2026; 33:43-57.
Multiple sclerosis (MS) is an autoimmune disorder affecting the central nervous system. This retrospective cohort study analyzed medical records of 98 MS patients to evaluate the predictive role of neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) in disease activity and severity. High NLR exhibited the strongest predictive value, with a cutoff >2.681 yielding sensitivity of 97.6% and specificity of 85.7% for severe disease. Elevated MLR was also associated with disease severity and activity, though less predictive than NLR. PLR was predictive of high disease activity but not severity. In conclusion, NLR is a strong and readily available biomarker for predicting MS activity and severity, outperforming MLR and PLR, and may aid early risk stratification and clinical decisions.
COI None financial but the slant of the post relates to work that will be coming your way soon..watch this space.
Disclaimer My views
Source: multiple-sclerosis-research.org