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Severe disease exacerbations in patients with multiple sclerosis after discontinuing fingolimod
Affiliations- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
- Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland
open access
Abstract
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.
Abstract
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.
Keywords
Multiple sclerosis, Fingolimod, Withdrawal, immune reconstitution inflammatory syndrome
About this articleTitle
Severe disease exacerbations in patients with multiple sclerosis after discontinuing fingolimod
Journal
Neurologia i Neurochirurgia Polska
Issue
Pages
156-162
Page views
415
Article views/downloads
507
DOI
10.1016/j.pjnns.2017.01.006
Bibliographic record
Neurol Neurochir Pol 2017;51(2):156-162.
Keywords
Multiple sclerosis
Fingolimod
Withdrawal
immune reconstitution inflammatory syndrome
Authors
Anna Członkowska
Łukasz Smoliński
Tomasz Litwin
