Fingolimod-Associated Peripheral Vascular Adverse Effects.
Fingolimod is the first oral disease-modifying drug approved for the treatment of multiple sclerosis. The drug is usually well tolerated, and common adverse effects include bradycardia, headache, influenza, diarrhea, back pain, increased liver enzyme levels, and cough. Fingolimod is thought to provide therapeutic benefit by preventing normal lymphocyte egress from lymphoid tissues, thus reducing the infiltration of autoaggressive lymphocytes into the central nervous system. However, because the drug acts on different sphingosine-1-phosphate receptors, it may induce several biological effects by influencing endothelial cell-cell adhesion, angiogenesis, vascular development, and cardiovascular function. We describe a patient with multiple sclerosis who, after 3 weeks of fingolimod administration, developed purplish blotches over the dorsal surface of the distal phalanges of the second and fifth digits and the middle phalanx of the fourth ray, itching, and edema on his left hand, without other evident clinical manifestations. When fingolimod therapy was discontinued, the clinical picture regressed within a few days but reappeared after a rechallenge test. Physicians should be aware of unexpected peripheral vascular adverse effects due to fingolimod use, and patients with vascular-based acropathies should be carefully screened and monitored when taking this drug.
IRCCS Centro Neurolesi "Bonino-Pulejo," Messina, Italy.
Margherita
M
Russo
Department of Social Territorial Medicine, Section of Dermatology, University of Messina, Messina, Italy.
Claudio
C
Guarneri
IRCCS Centro Neurolesi "Bonino-Pulejo," Messina, Italy.
Emanuela
E
Mazzon
IRCCS Centro Neurolesi "Bonino-Pulejo," Messina, Italy.
Edoardo
E
Sessa
IRCCS Centro Neurolesi "Bonino-Pulejo," Messina, Italy.
Placido
P
Bramanti
IRCCS Centro Neurolesi "Bonino-Pulejo," Messina, Italy. Electronic address: salbro77@tiscali.it.
Rocco Salvatore
RS
Calabrò
D000328:Adult; D016903:Drug Monitoring; D005385:Fingers / Q000098:blood supply*; D000068876:Fingolimod Hydrochloride / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D009103:Multiple Sclerosis / Q000188:drug therapy*; D016491:Peripheral Vascular Diseases / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control; D012212:Rheology / Q000379:methods; D016896:Treatment Outcome; D028761:Withholding Treatment
D007166:Immunosuppressive Agents; D000068876:Fingolimod Hydrochloride