Figure 4. MSBase and US chart review: (A and B) Post-treatment lymphocyte reconstitution for patients after discontinuing treatment with DMF through starting another DMT and (C) post-DMF DMTs.

For patients who switched to fingolimod, natalizumab, rituximab, or ocrelizumab after DMF discontinuation, only the ALC observations taken before starting these treatments are included. ^aPatients could have sequentially switched to >1 DMT; only the patient's first alternative DMT after DMF discontinuation is shown. No patients reinstated DMF after discontinuation. (A) The mixed-effect model regresses absolute ALC measure on log2-transformed time (days) since discontinuation of DMF with random intercept and slope, adjusted for age at discontinuation, ALC group at discontinuation (<0.5 × 10⁹/L or ≥0.5 × 10⁹/L), and the interaction between the log2-transformed time and ALC group. The last ALC on DMF is assumed to be measured on day 1 after discontinuation. A month is assumed to be 30 days. The estimates at each time point are based on the fitted model with standard errors and CIs given using Kenward-Roger approximation. (B) ALC measures are shown for individual patients, and each patient's line ends when the patient begins an alternate therapy. ALC = absolute lymphocyte count; DMF = dimethyl fumarate; DMT = disease-modifying therapy; LLN = lower limit of normal.