title: Fingolimod treatment in multiple sclerosis leads to increased macular volume.
abstract: OBJECTIVE
  To determine whether fingolimod, an oral sphingosine-1-phosphate receptor modulator approved for treatment of multiple sclerosis (MS), generally leads to increased retinal tissue volume.
  
  
  METHODS
  In this longitudinal observational study, we compared changes in macular volume on spectral-domain optical coherence tomography (OCT) between consecutive patients with MS who initiated fingolimod and a matched reference cohort of patients with MS never exposed to the drug. The primary reference cohort was matched based on time interval between OCT examinations. A secondary reference cohort was matched based on age and disease duration. Change in macular volume within each group was analyzed using the paired t test. Change in macular volume between groups was examined using multiple linear regression.
  
  
  RESULTS
  Macular volume increased by a mean of 0.025 mm3 (95% confidence interval [CI] +0.017 to +0.033, p < 0.001) in the 30 patients with MS who initiated fingolimod over a mean follow-up time of 5 months (SD 3). Macular volume did not significantly change over a mean follow-up time of 6 months (SD 4) in a comparison group of 30 patients with MS never treated with fingolimod (mean change of -0.003 mm3, 95% CI -0.009 to +0.004, p = 0.47). Overall, 74% of eyes in the fingolimod-treated group exhibited an increase in macular volume vs. 37% of eyes in the comparison group.
  
  
  CONCLUSIONS
  Initiation of fingolimod in MS is associated with a modest, relatively rapid increase in macular volume.
authors.affiliation: Multiple Sclerosis Center, UCSF Department of Neurology, San Francisco, CA, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Nolan
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Gelfand
authors.forename: Ari J
authors.initials: AJ
authors.lastname: Green
mesh_terms: D000328:Adult; D005260:Female; D000068876:Fingolimod Hydrochloride; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016014:Linear Models; D008137:Longitudinal Studies; D008266:Macula Lutea / Q000473:pathology*; D008297:Male; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000473:pathology; D011409:Propylene Glycols / Q000627:therapeutic use*; D049349:Receptors, Lysosphingolipid / Q000037:antagonists & inhibitors; D055351:Retinal Neurons / Q000473:pathology; D013110:Sphingosine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D041623:Tomography, Optical Coherence
chemical_list: D007166:Immunosuppressive Agents; D011409:Propylene Glycols; D049349:Receptors, Lysosphingolipid; D000068876:Fingolimod Hydrochloride; D013110:Sphingosine