Fingolimod Rebound: A Review of the Clinical Experience and Management Considerations.
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TLDR
Of the US Food and Drug Administration-approved agents to treat MS, the drugs most commonly implicated in rebound are natalizumab and fingolimod, and what evidence is available to help clinicians mitigate the risk of rebound, switch therapies, and treat rebound events when they occur is summarized.Abstract:
Because the treatment of multiple sclerosis (MS) may span decades, the need often arises to make changes to the treatment plan in order to accommodate changing circumstances. Switching drugs, or the discontinuation of immunomodulatory agents altogether, may leave patients vulnerable to relapse or disease progression. In some cases, severe MS disease activity is noted clinically and on MRI after treatment withdrawal. When this disease activity is disproportionate to the pattern observed prior to treatment initiation, patients are said to have experienced rebound. Of the US Food and Drug Administration (FDA)-approved agents to treat MS, the drugs most commonly implicated in rebound are natalizumab and fingolimod. In this review based on the reported cases and data from clinical trials, we characterize disease rebound after fingolimod cessation. We also outline fingolimod rebound management considerations, summarizing what evidence is available to help clinicians mitigate the risk of rebound, switch therapies, and treat rebound events when they occur. The commonly encountered situation of fingolimod discontinuation prior to pregnancy is also discussed.read more
Citations
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COVID-19 Vaccine Response in People with Multiple Sclerosis.
Emma C. Tallantyre,Emma C. Tallantyre,Nicola Vickaryous,Valerie Anderson,Aliye Nazli Asardag,David Baker,Jonathan P. Bestwick,Kath Bramhall,Randy Chance,Nikos Evangelou,Katila George,Gavin Giovannoni,Gavin Giovannoni,Andrew James Godkin,Andrew James Godkin,Leanne Grant,Katharine Harding,Aimee Hibbert,Gillian Ingram,Meleri Jones,Angray S. Kang,Samantha Loveless,Stuart J. Moat,Stuart J. Moat,Neil Robertson,Neil Robertson,Klaus Schmierer,Klaus Schmierer,Martin J. Scurr,Sita Navin Shah,Jessica Simmons,Matthew Upcott,Mark Willis,Stephen Jolles,Stephen Jolles,Ruth Dobson,Ruth Dobson +36 more
TL;DR: In this article, the authors investigated the effect of disease modifying therapies on immune response to severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) vaccines in people with MS.
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Multiple Sclerosis Disease-Modifying Therapy and the COVID-19 Pandemic: Implications on the Risk of Infection and Future Vaccination.
Crystal Zheng,Indrani Kar,Claire Kaori Chen,Crystal Sau,Crystal Sau,Sophia Woodson,Alessandro Serra,Alessandro Serra,Hesham Abboud +8 more
TL;DR: Disease-modifying therapies are reviewed and compared in terms of their effect on the immune system, published infection rates, potential impact on SARS-CoV-2 susceptibility, and vaccine-related implications.
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COVID-19 infection in a patient with multiple sclerosis treated with fingolimod.
Mahdi Barzegar,Omid Mirmosayyeb,Nasim Nehzat,Reza Sarrafi,Farzin Khorvash,Amir-Hadi Maghzi,Vahid Shaygannejad +6 more
TL;DR: A patient with MS treated with fingolimod who was diagnosed with COVID-19 and had a favorable outcome is presented.
Journal ArticleDOI
Multiple Sclerosis Therapy Consensus Group (MSTCG): position statement on disease-modifying therapies for multiple sclerosis (white paper):
H. Wiendl,Ralf Gold,Thomas Berger,Tobias Derfuss,Ralf A. Linker,Mathias Mäurer,Orhan Aktas,Karl Baum,Martin Berghoff,Stefan Bittner,Andrew T. Chan,Adam Czaplinski,Florian Deisenhammer,Franziska Di Pauli,Renaud Du Pasquier,Christian Enzinger,Elisabeth Fertl,Achim Gass,Klaus Gehring,Claudio Gobbi,Norbert Goebels,Michael Guger,Aiden Haghikia,Hans-Peter Hartung,Fedor Heidenreich,Olaf Hoffmann,Boris Kallmann,Christoph Kleinschnitz,Luisa Klotz,Verena I. Leussink,Fritz Leutmezer,Volker Limmroth,Jan D. Lünemann,Andreas Lutterotti,Sven G. Meuth,Uta Meyding-Lamadé,Michael Platten,Peter Rieckmann,Stephan Schmidt,Hayrettin Tumani,Frank Weber,Martin S. Weber,Uwe K. Zettl,Tjalf Ziemssen,Frauke Zipp +44 more
TL;DR: In this article, the authors focused on the most important recommendations for disease-modifying therapies of multiple sclerosis in 2021 and applied to those medications approved in wide parts of Europe, particularly German-speaking countries (Germany, Austria, and Switzerland).
Journal ArticleDOI
COVID-19 in teriflunomide-treated patients with multiple sclerosis.
Amir-Hadi Maghzi,Maria K. Houtchens,Paolo Preziosa,Carolina Ionete,Biljana D. Beretich,James Stankiewicz,Shahamat Tauhid,Ann Cabot,Idanis Berriosmorales,Tamara H.W. Schwartz,Jacob A. Sloane,Mark S. Freedman,Massimo Filippi,Howard L. Weiner,Rohit Bakshi +14 more
TL;DR: The patients continued teriflunomide therapy and had self-limiting infection, without relapse of their MS, and these observations have implications for the management of MS in the setting of the COVID-19 pandemic.
References
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Chris H. Polman,Eva Havrdova,Michael Hutchinson,Ludwig Kappos,David Miller,J. Theodore Phillips,Fred D. Lublin,Gavin Giovannoni,A Wajgt,Martin Toal,F Lynn,Michael Panzara,Alfred Sandrock +12 more
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TL;DR: Both doses of oral fingolimod improved the relapse rate, the risk of disability progression, and end points on MRI and were superior to placebo with regard to MRI-related measures.
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TL;DR: This trial showed the superior efficacy of oral fingolimod with respect to relapse rates and MRI outcomes in patients with multiple sclerosis, as compared with intramuscular interferon beta-1a.
Journal ArticleDOI
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TL;DR: In vitro adhesion assay on tissue sections found that lymphocytes and monocytes bound selectively to inflamed EAE brain vessels, and therapies designed to interfere with α4βl integrin may be useful in treating inflammatory diseases of the central nervous system, such as multiple sclerosis.
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The immunopathology of multiple sclerosis: An overview
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