title: Fingolimod in a patient with heart failure on the background of pulmonary arterial hypertension and coronary artery disease.
abstract: BACKGROUND
  Fingolimod is the first oral immunomodulatory therapy approved for highly active relapsing remitting multiple sclerosis. Based on the distribution pattern of fingolimod interacting sphingosine-1-phosphat receptors in organism including immune system and cardiovascular system clinical monitoring of patients and evaluation of adverse events are recommended. Despite extensive data on cardiovascular safety, experience with fingolimod in patients with concomitant cardiological disease, especially within the pulmonary circulation, is rare.
  
  
  METHODS
  We report the case of a 46-year-old woman presented with relapsing remitting multiple sclerosis and severe idiopathic pulmonary arterial hypertension. Fingolimod was initiated because of disease activity of multiple sclerosis with two relapses and gadolinium-enhancing lesions in MRI. The patient demonstrated stable disease course of idiopathic pulmonary arterial hypertension when fingolimod was started. Fingolimod therapy did not alter or even worsen the pulmonary or cardiovascular conditions during first dose application as well as follow up of nine months.
  
  
  CONCLUSIONS
  In this report, we present the first case of fingolimod treatment in a patient with highly active multiple sclerosis and severe idiopathic pulmonary arterial hypertension. We suggest an interdisciplinary approach with detailed cardiopulmonary monitoring for safety in such patients.
authors.forename: Katja
authors.initials: K
authors.lastname: Thomas
authors.forename: Hagen
authors.initials: H
authors.lastname: Schrötter
authors.forename: Michael
authors.initials: M
authors.lastname: Halank
authors.affiliation: Center of Clinical Neuroscience, Department of Neurology, Neurological University Clinic Dresden, University Clinic Carl Gustav Carus Dresden, University of Technology Dresden, Fetscherstr, 74, 01307 Dresden, Germany. Tjalf.Ziemssen@uniklinikum-dresden.de.
authors.forename: Tjalf
authors.initials: T
authors.lastname: Ziemssen
mesh_terms: D003324:Coronary Artery Disease / Q000150:complications*; D005260:Female; D000068876:Fingolimod Hydrochloride; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications*; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications* / Q000188:drug therapy*; D011409:Propylene Glycols / Q000009:adverse effects* / Q000627:therapeutic use; D013110:Sphingosine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D007166:Immunosuppressive Agents; D011409:Propylene Glycols; D000068876:Fingolimod Hydrochloride; D013110:Sphingosine