title: Severe disease exacerbations in patients with multiple sclerosis after discontinuing fingolimod.
abstract: Discontinuation of fingolimod in patients with multiple sclerosis (MS) can lead to disease reactivation. In this review, we describe cases of severe exacerbations in patients with MS following discontinuation of fingolimod, including three cases from our center. We consider potential mechanisms of disease reactivation after cessation of fingolimod, and the evidence supporting this rebound effect. We conclude that discontinuation of fingolimod results in the return of disease activity, which then leads to severe exacerbations (i.e., rebounds) in a clinically significant proportion of patients. Lastly, we consider disease-modifying treatment options for patients who discontinue fingolimod.
authors.affiliation: Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland. Electronic address: czlonkow@ipin.edu.pl.
authors.forename: Anna
authors.initials: A
authors.lastname: Członkowska
authors.affiliation: Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland.
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Smoliński
authors.affiliation: Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Litwin
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology; D018450:Disease Progression; D057915:Drug Substitution; D005260:Female; D000068876:Fingolimod Hydrochloride / Q000009:adverse effects* / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008231:Lymphopenia / Q000139:chemically induced / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy*; D013116:Spinal Cord / Q000473:pathology; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis*
chemical_list: D000068876:Fingolimod Hydrochloride
keywords: Fingolimod; Multiple sclerosis; Withdrawal, immune reconstitution inflammatory syndrome