title: Fingolimod: therapeutic mechanisms and ocular adverse effects.
abstract: Fingolimod is an oral immunomodulating drug used in the management of relapsing-remitting multiple sclerosis (RRMS). We aim to review the published literature on ocular manifestations of fingolimod therapy and their possible underlying mechanisms. The therapeutic effects of fingolimod are mediated via sphingosine receptors, which are found ubiquitously in various organs, including lymphoid cells, central nervous system, cardiac myocytes, and smooth muscle cells. Fingolimod-associated macular oedema (FAME) is the most common ocular side effect but retinal haemorrhages and retinal vein occlusion can occur. The visual consequences appear to be mild and, in cases of FAME, resolution is often attained with discontinuation of therapy. However, in cases of retinal vein occlusion, discontinuation of fingolimod alone may not be sufficient and intra-vitreal therapy may be required. We also propose a pragmatic service pathway for monitoring patients on fingolimod therapy, which includes stratifying them by risk and visual acuity.
authors.affiliation: Department of Ophthalmology, The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, UK.
authors.forename: P
authors.initials: P
authors.lastname: Mandal
authors.affiliation: Department of Ophthalmology, The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, UK.
authors.forename: A
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Department of Ophthalmology, The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, UK.
authors.forename: W
authors.initials: W
authors.lastname: Fusi-Rubiano
authors.affiliation: NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK.|Institute of Ophthalmology, University College London, London, UK.
authors.forename: P A
authors.initials: PA
authors.lastname: Keane
authors.affiliation: Department of Ophthalmology, The Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, UK.|School of Life & Health Sciences, Aston University, Birmingham, UK.
authors.forename: Y
authors.initials: Y
authors.lastname: Yang
mesh_terms: D000068876:Fingolimod Hydrochloride / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D012160:Retina / Q000187:drug effects; D012164:Retinal Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D018570:Risk Assessment / Q000379:methods; D014792:Visual Acuity
chemical_list: D007166:Immunosuppressive Agents; D000068876:Fingolimod Hydrochloride