Fingolimod: neurological complications
Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .
Fingolimod: neurological complications. The frequency is about 25%. Fully referenced neurology checklist.
Fingolimod rebound of MS on withdrawal
- The frequency is about 25%
- Most cases occur 2-6 months after treatment withdrawal
- A high relapse rate pre-treatment may increase the risk
- Treatment is with Steroids, plasma exchange (PE), Rituximab, or Ocrelizumab
- Cladribine has also been used successfully: case report
- Switching to Natalizumab or Alemtuzumab may be effective
- A 6-week washout period may mitigate the risk: but this may be too long in some cases
Tumefactive demyelination
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Other neurological complications
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References
- Hatcher SE, Waubant E, Nourbakhsh B, Crabtree-Hartman E, Graves JS. Rebound syndrome in patients with multiple sclerosis after cessation of fingolimod treatment. JAMA Neurol 2016; 73:790-794.
- Barry B, Erwin AA, Stevens J, Tornatore C. Fingolimod rebound: a review of the clinical experience and management considerations. Neurol Ther 2019; 8:241-250.
- Forci B, Mariottini A, Mechi C, Massacesi L, Repice A. Disease reactivation following fingolimod withdrawal in multiple sclerosis: two case reports. Mult Scler Relat Disord 2017; 15:24-26.
- Frau J, Sormani MP, Signori A, et al; i-MuST study group. Clinical activity after fingolimod cessation: disease reactivation or rebound? Eur J Neurol 2018; 25:1270-1275.
- Faissner S, Hoepner R, Lukas C, Chan A, Gold R, Ellrichmann G. Tumefactive multiple sclerosis lesions in two patients after cessation of fingolimod treatment. Ther Adv Neurol Disord 2015; 8:233-238.
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