Fingolimod in the treatment algorithm of relapsing remitting multiple sclerosis: a statement of the Central and East European (CEE) MS Expert Group.
Fingolimod is the first oral treatment of multiple sclerosis. It is the first-in-class sphingosine 1-phosphate receptor modulator that binds to sphingosine 1-phophate receptors on lymphocytes and via downregulation of the receptor prevents lymphocyte egress from lymphoid tissues into the circulation. This mechanism reduces the infiltration of potentially auto-aggressive lymphocytes into the central nervous system. Two large phase III studies with fingolimod have shown superior efficacy of the drug in two dosages compared to placebo and to weekly intramuscular injections of Interferon beta-1a. Among possible side effects of the drug is a transient bradycardia after the first dose of fingolimod including possible AV blockade and therefore monitoring of pulse rate and blood pressure for 6 h following the first application is needed. During treatment, attention has to be given to specific infections, elevated liver enzymes, and ophthalmologic changes. Recommendations on the use of fingolimod including safety aspects are given in this article.
Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036 Graz, Austria. franz.fazekas@medunigraz.at
Franz
F
Fazekas
Thomas
T
Berger
Tanja Hojs
TH
Fabjan
Alenka Horvat
AH
Ledinek
Gábor
G
Jakab
Samuel
S
Komoly
Jörg
J
Kraus
Egon
E
Kurča
Theodoros
T
Kyriakides
L'ubomír
L
Lisý
Ivan
I
Milanov
Panayiotis
P
Panayiotou
Sasa Sega
SS
Jazbec
Radomír
R
Taláb
Latchezar
L
Traykov
Peter
P
Turčáni
Karl
K
Vass
Norbert
N
Vella
Eva
E
Havrdová
D000284:Administration, Oral; D000465:Algorithms; D002986:Clinical Trials as Topic; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D000068876:Fingolimod Hydrochloride; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects / Q000627:therapeutic use; D007156:Immunologic Memory / Q000187:drug effects; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000068556:Interferon beta-1a; D016899:Interferon-beta / Q000009:adverse effects / Q000627:therapeutic use; D018655:Lymphocyte Count; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy* / Q000276:immunology; D011409:Propylene Glycols / Q000009:adverse effects / Q000627:therapeutic use*; D013110:Sphingosine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013601:T-Lymphocytes / Q000187:drug effects; D016896:Treatment Outcome
D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D011409:Propylene Glycols; D016899:Interferon-beta; D000068876:Fingolimod Hydrochloride; D013110:Sphingosine; D000068556:Interferon beta-1a