title: Rebound of disease activity after withdrawal of fingolimod (FTY720) treatment.
abstract: BACKGROUND
  The oral sphingosine-1-phosphate receptor modulator fingolimod (FTY720) was recently approved for the treatment of relapsing-remitting multiple sclerosis. To date, data about a possible recurrence of disease activity after discontinuation of fingolimod treatment are scarce.
  
  
  OBJECTIVE
  To describe a patient who discontinued fingolimod treatment after a local malignant melanoma was diagnosed. Three months after cessation, he had a striking rebound of multiple sclerosis activity.
  
  
  METHODS
  Case report and review of literature.
  
  
  METHODS
  Institute of Clinical Neuroimmunology, Ludwig-Maximilians-University, Munich, Germany.
  
  
  METHODS
  A 45-year-old man diagnosed as having relapsing-remitting multiple sclerosis.
  
  
  METHODS
  Multiple sclerosis disease activity including annual relapse rate, Expanded Disability Status Scale score, and number of gadolinium-enhancing lesions on magnetic resonance imaging before, during, and after treatment with fingolimod.
  
  
  RESULTS
  Three months after discontinuation of treatment with fingolimod, the patient experienced a severe relapse, with Expanded Disability Status Scale score progression from 2.5 to 4.5. On brain and spinal magnetic resonance imaging, he showed a rebound of disease activity, with a drastic increase of gadolinium-enhancing lesions (>20).
  
  
  CONCLUSIONS
  Two aspects relevant to any newly approved multiple sclerosis treatment with immunomodulatory properties are highlighted with this case: first, possible rebound of disease activity after discontinuation; second, the occurrence of a tumor as a possible treatment-related complication.
authors.affiliation: Institute of Clinical Neuroimmunology, Ludwig-Maximilians-University, Marchioninistr 15, 81377 Munich, Germany.
authors.forename: Joachim B
authors.initials: JB
authors.lastname: Havla
authors.forename: Hannah L
authors.initials: HL
authors.lastname: Pellkofer
authors.forename: Ingrid
authors.initials: I
authors.lastname: Meinl
authors.forename: Lisa Ann
authors.initials: LA
authors.lastname: Gerdes
authors.forename: Reinhard
authors.initials: R
authors.lastname: Hohlfeld
authors.forename: Tania
authors.initials: T
authors.lastname: Kümpfel
mesh_terms: D001921:Brain / Q000473:pathology; D004185:Disability Evaluation; D018450:Disease Progression; D000068876:Fingolimod Hydrochloride; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D016899:Interferon-beta / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008545:Melanoma / Q000150:complications*; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D011409:Propylene Glycols / Q000627:therapeutic use*; D012008:Recurrence; D013110:Sphingosine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D007155:Immunologic Factors; D011409:Propylene Glycols; D016899:Interferon-beta; D000068876:Fingolimod Hydrochloride; D013110:Sphingosine