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Neurological problems
Published in Catherine Nelson-Piercy, Handbook of Obstetric Medicine, 2020
Fingolimod is an immunomodulator used for severe progressive MS. Fingolimod is teratogenic in animals and human data suggest a twofold increased risk of major congenital malformations including cardiac, renal and musculoskeletal defects, when used in pregnancy. Women of childbearing potential must use effective contraception during fingolimod treatment and for 2 months after discontinuation.
Central nervous system viral infections complicating immunosuppression
Published in Avindra Nath, Joseph R. Berger, Clinical Neurovirology, 2020
Fingolimod is an oral immunomodulating drug approved in 2010 by the US Food and Drug Administration; it acts via downregulation of sphingosine-1-phosphate receptors on lymphocytes with resultant sequestration of lymphocytes in secondary lymphoid organs. Although CD8 effector T cells are less affected, there is an increase in VZV infections including disseminated cases. The selective increase in VZV infection may in part be explained by the relative paucity of VZV-specific memory T cells in the blood of immune patients, their frequency being 50% of those specific to HSV and less than a tenth of CMV-related memory T cells [26]. Of the 149 cases of VZV infection reported by Arvin, 84% were uncomplicated dermatomal zoster and 7% were VZV ophthalmicus [27]. Disseminated VZV, herpes simplex encephalitis, and disseminated cryptococcosis have been reported rarely [28]. CD4:CD8 ratios are similar to those of AIDS patients. Current reported PML frequency is about 1:18,000 patients [29]. The manufacturer recommends checking VZV immune status before therapy, vaccination before therapy if indicated and regular monitoring for lymphopenia. All adults who are not immune to VZV should receive 2 doses of life-attenuated Varivax 4 weeks apart. Those without a history of vaccination of documented VZV born in the IS after 1980 should also be vaccinated. Seropositive adults do not need vaccination and, as the VZV vaccine is live-attenuated, it should be given to nonimmunocompromised patients one month before the start of disease-modifying therapies.
Neurological conditions
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Fingolimod is a sphingosine 1-phosphate receptor modulator, which sequesters lymphocytes in lymph nodes, preventing them from contributing to an autoimmune reaction. This drug should be discontinued at least 2 months before conception due to a presumed teratogenic risk shown in animals.
Disorders of vision in multiple sclerosis
Published in Clinical and Experimental Optometry, 2022
Roshan Dhanapalaratnam, Maria Markoulli, Arun V Krishnan
Fingolimod was the first oral disease-modifying agent used in multiple sclerosis and remains one of the most widely used oral agents for multiple sclerosis. It is a sphingosine 1-phosphate receptor modulator, and limits the lymphocyte egress from lymph nodes, and subsequently reduces the degree of lymphocyte infiltration into the CNS and thereby inflammatory exacerbations of multiple sclerosis.91 Fingolimod is known to cause macular oedema at a rate of 0.5% of patients on the drug.92 For this reason, it is recommended that OCT is performed prior to initiating fingolimod and is repeated at three months following commencement of treatment. If detected, macular oedema tends to resolve with cessation of the drug. The risk of macular oedema is increased in those with diabetes or uveitis.
Short-term laboratory and related safety outcomes for the multiple sclerosis oral disease-modifying therapies: an observational study
Published in Expert Opinion on Drug Safety, 2021
Elaine Kingwell, Tingting Zhang, Feng Zhu, Randy Walld, Robert Carruthers, Charity Evans, Ruth Ann Marrie, Helen Tremlett
Among PwMS with a normal baseline test result (see Supplementary Figure 1), ALT was elevated (>ULN) at least once in 30.0% of fingolimod users, 12.4% of teriflunomide users, and 13.2% of DMF users. Liver toxicity was observed in 2.8% of fingolimod users. For DMF users, lymphopenia was detected in 3.1%, and proteinuria in 2.9%, at least once (see Table 2). The incidence rates [IR] per 100 person-years for the de novo events, and corresponding 95% confidence intervals [95% CI], are shown in Table 2. For ALT>ULN, the IR ranged from 17.80 (95%CI 13.20; 23.45) for DMF to 25.96 (95% CI 15.12; 41.57) for teriflunomide, while the IRs were 4.03 (95% CI 2.25; 6.64) for lymphopenia and 3.74 (95% CI 1.71; 7.10) for proteinuria with DMF use, and 1.87 (95% CI 0.69; 2.40) for liver toxicity with fingolimod use. Overall, the IRs were consistent between the subgroups that differed by age, SES, or exposure to non-oral DMTs (data not shown). However, for fingolimod only, elevated ALT was observed more frequently for men (IRmen 47.56; 95% CI 30.78; 79.20) than for women (IRwomen 19.05, 95% CI 13.54; 26.04), although the liver toxicity findings did not differ by sex (IRmen1.21, 95% CI 0.03; 6.74); IRwomen 2.10, 95% CI 0.68; 4.90).
Evaluation of the effect of fingolimod (FTY720) on macular perfusion by swept-source optical coherence tomography angiography in patients with multiple sclerosis
Published in Cutaneous and Ocular Toxicology, 2020
Yalçın Karaküçük, Haluk Gümüş, Serhat Eker
Fingolimod hydrochloride (FTY720) is a sphingosine-1-phosphate (S1P) receptor modulator, approved by the Food and Drug Administration (FDA) and the National Institute for Health and Care (NICE) to treat RR-MS patients4,5. It binds to S1P receptors on the surface of T-lymphocytes, causing the cells to internalise the treatment and be destroyed. Fingolimod prevents lymphocytes from passing out of the lymphoid tissues into the peripheral circulation and the CNS. Thus, it stops lymphocytes from attacking myelin. Fingolimod is an effective drug, which significantly decreases the number of relapses in RR-MS patients, slows disability progression, reduces inflammatory activity, and lowers the cerebral volume loss rate in MRI lesions6,7.