title: Effect of Fingolimod on Platelet Count Among Multiple Sclerosis Patients.
abstract: BACKGROUND
  While many studies have previously focused on fingolimod's effect on immune cells, the effect it has on circulating and local central nervous system platelets (Plts) has not yet been investigated. This study will elucidate what effects fingolimod treatment has on multiple sclerosis (MS) patients' plasma Plt levels. In addition, it will propose possible reasoning for these effects and suggest further investigation into this topic.
  
  
  METHODS
  This quasi-experimental study used patients from the Isfahan Multiple Sclerosis Society to produce a subject pool of 80 patients, including 14 patients who ceased fingolimod use due to complications. The patients had their blood analyzed to determine Plt levels both 1-month prior to fingolimod treatment and 1-month after fingolimod treatment had been started.
  
  
  RESULTS
  The mean level of Plts before initiation of fingolimod therapy (Plt1) among these MS patients was 256.53 ± 66.26. After 1-month of fingolimod treatment, the Plt level yielded an average of 229.96 ± 49.67 (Plt2). This number is significantly lower than the average Plt count before treatment (P < 0.01).
  
  
  CONCLUSIONS
  MS patients taking oral fingolimod treatment may be at risk for side-effects caused by low Plt levels. This may not be a factor for patients with higher or normal Plt levels. However, a patient with naturally low Plt levels may experience a drop below the normal level and be at risk for excessive bleeding. In addition to these possible harmful side-effects, the decreased Plt population may pose positive effects for MS patients.
authors.affiliation: Department of Immunology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neurosciences Research Centre, Affiliated to Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Farrokhi
authors.affiliation: Department of Immunology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neurosciences Research Centre, Affiliated to Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Ali Amani
authors.initials: AA
authors.lastname: Beni
authors.affiliation: Isfahan Neurosciences Research Centre, Affiliated to Isfahan University of Medical Sciences, Isfahan, Iran; Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Multiple Sclerosis and Neuroimmunology Research Center, Isfahan, Iran.
authors.forename: Masoud
authors.initials: M
authors.lastname: Etemadifar
authors.affiliation: Department of Molecular Biology, Cell Biology, and Biochemistry, Brown University, Providence, Rhode Island 02912, USA; Department of Neuroscience, Brown University, Providence, Rhode Island 02912, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Rezaei
authors.affiliation: Department of Molecular Biology, Cell Biology, and Biochemistry, Brown University, Providence, Rhode Island 02912, USA; Department of Neuroscience, Brown University, Providence, Rhode Island 02912, USA.
authors.forename: Leah
authors.initials: L
authors.lastname: Rivard
authors.affiliation: Department of Immunology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Aryan Rafiee
authors.initials: AR
authors.lastname: Zadeh
authors.affiliation: Isfahan Neurosciences Research Centre, Affiliated to Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Nahid
authors.initials: N
authors.lastname: Sedaghat
authors.affiliation: Department of Electrical and Computer Engineering, Isfahan University of Technology, Isfahan, Iran; Department of Immunology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran.
authors.forename: Milad
authors.initials: M
authors.lastname: Ghadimi
keywords: Fingolimod; multiple sclerosis; platelet