Friday, 27 July 2012

Rebound in MS disease activity on fingolimod withdrawal

Epub: Hakiki et al. Withdrawal of fingolimod treatment for relapsing-remitting multiple sclerosis: report of six cases. Mult Scler. 2012 Jul.

The objective of this study is to report the limited experience on fingolimod suspension in MSers. The clinical and MRI outcomes are presented in 6 MSers after fingolimod discontinuation. Within three months from fingolimod suspension, 5 MSers returned to pre-treatment disease activity; one MSer , however, exhibited a clear rebound of clinical and MR activity. These findings suggest that clinical and MR outcomes after fingolimod suspension can vary among MSers. Systematic collection of clinical, laboratory and imaging data is highly advisable to identify subjects who are at higher risk of rebound and to define effective management strategies in these subjects.


"What this early experience is telling us is that if your MS is well controlled on fingolimod and you stop fingolimod your disease rebounds about 3 months later. This fits with the timing of the drug washing out of your body."

"These observations of rebound is not surprising as fingolimod does not work by rebooting our immune system; it works by trapping white blood cells in lymph nodes. If you remove this block the white blood cells are then able to move out of the lymph nodes and into the brain and spinal cord and trigger clinical attacks and new MRI lesions. This same thing happens with natalizumab."

2 comments:

  1. 'Fingolimod does not work by rebooting our immune system'. Natalizumab does not reboot the immune system either.
    Alemtuzumab does reboot the immune system.
    What about ocrelizumab/rituximab?

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  2. Re: "What about ocrelizumab/rituximab?"

    They only reboot the B-cell pool and not the antibody factory cells that are called plasma cells. You have to remember that EBV lives inside B cells and hence the effect of these drugs could be via their anti-EBV or anti-viral effect. Interestingly all the more effective drugs seem to target B cells. So my money is on this cell or EBV being the culprit.

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