title: Fingolimod therapy for multiple sclerosis.
abstract: Because of its potent efficacy and oral route of administration, the approval of fingolimod as treatment for relapsing-remitting multiple sclerosis (MS) was highly anticipated. The therapeutic and adverse effects are mediated by modulation of sphingosine 1-phosphate receptors. Fingolimod inhibits the egress of lymphocytes from lymph nodes and may also have direct effects on the central nervous system. The clinical trials that led to the approval of fingolimod demonstrated benefit on relapses, disability progression, magnetic resonance imaging (MRI) activity, and brain volume loss in treatment-naïve and previously treated patients with relapsing-remitting MS. The use of fingolimod in clinical practice has been limited by concerns for cardiac effects, infection, and macular edema as well as the relative lack of long-term safety data for this drug with a novel mechanism of action. Additional clinical trial and postmarketing data suggest that fingolimod is a safe, effective, and well-tolerated treatment option when patients are selected and monitored appropriately.
authors.affiliation: Neurological Institute, The Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH 44195, USA. cohenj@ccf.org
authors.forename: Mary A
authors.initials: MA
authors.lastname: Willis
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Cohen
mesh_terms: D002490:Central Nervous System / Q000187:drug effects*; D000068876:Fingolimod Hydrochloride; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008246:Lysophospholipids / Q000378:metabolism*; D009103:Multiple Sclerosis / Q000188:drug therapy*; D011409:Propylene Glycols / Q000009:adverse effects / Q000627:therapeutic use*; D013110:Sphingosine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000378:metabolism / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D008246:Lysophospholipids; D011409:Propylene Glycols; C060506:sphingosine 1-phosphate; D000068876:Fingolimod Hydrochloride; D013110:Sphingosine