Severe disease exacerbations in patients with multiple sclerosis after discontinuing fingolimod

Discontinuation of fingolimod in patients with multiple sclerosis (MS) can lead to disease reactivation. In this review, we describe cases of severe exacerbations in patients with MS following discontinuation of fingolimod, including three cases from our center. We consider potential mechanisms of d...

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Bibliographic Details
Published in:Neurologia i neurochirurgia polska 2017-03, Vol.51 (2), p.156-162
Main Authors: Członkowska, Anna, Smoliński, Łukasz, Litwin, Tomasz
Format: Article
Language:English
Subjects:
Adult
Brain - pathology
Clinical significance
Disease Progression
Drug Substitution
Female
Fingolimod
Fingolimod Hydrochloride - adverse effects
Fingolimod Hydrochloride - therapeutic use
Follow-Up Studies
Humans
Lymphopenia - chemically induced
Lymphopenia - diagnosis
Magnetic Resonance Imaging
Male
Middle Aged
Multiple sclerosis
Multiple Sclerosis - chemically induced
Multiple Sclerosis - diagnosis
Multiple Sclerosis - drug therapy
Spinal Cord - pathology
Substance Withdrawal Syndrome - diagnosis
Withdrawal, immune reconstitution inflammatory syndrome
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Summary:Discontinuation of fingolimod in patients with multiple sclerosis (MS) can lead to disease reactivation. In this review, we describe cases of severe exacerbations in patients with MS following discontinuation of fingolimod, including three cases from our center. We consider potential mechanisms of disease reactivation after cessation of fingolimod, and the evidence supporting this rebound effect. We conclude that discontinuation of fingolimod results in the return of disease activity, which then leads to severe exacerbations (i.e., rebounds) in a clinically significant proportion of patients. Lastly, we consider disease-modifying treatment options for patients who discontinue fingolimod.
ISSN:0028-3843
1897-4260
DOI:10.1016/j.pjnns.2017.01.006