Case Report: Rebound of disease after fingolimod cessation

Havla et al. Rebound of disease activity after withdrawal of fingolimod (FTY720) treatment. Arch Neurol. 2012;69:262-4.

BACKGROUND: The oral sphingosine-1-phosphate receptor modulator fingolimod (FTY720/Gilenya) was recently approved for the treatment of relapsing-remitting multiple sclerosis. To date, data about a possible recurrence of disease activity after discontinuation of fingolimod treatment are scarce.

OBJECTIVE: To describe a patient who discontinued fingolimod treatment after a local malignant melanoma was diagnosed. Three months after cessation, he had a striking rebound of multiple sclerosis activity.

RESULTS: Three months after discontinuation of treatment with fingolimod, the patient experienced a severe relapse, with Expanded Disability Status Scale score progression from 2.5 to 4.5. On brain and spinal magnetic resonance imaging, he showed a rebound of disease activity, with a drastic increase of gadolinium-enhancing lesions (more than 20).

CONCLUSIONS: Two aspects relevant to any newly approved multiple sclerosis treatment with immunomodulatory properties are highlighted with this case: first, possible rebound of disease activity after discontinuation; second, the occurrence of a tumor as a possible treatment-related complication.

Gilenya works by stopping white blood cells from exiting the lymph glands so it empties the blood of white blood cells. This can stop MS and also immune survellience that could cause cancers. It is possible that once you stop the drug, the cells can leave the lymph glands, enter the blood and then get in the brain to cause disease. Are these two effects linked well we can not say, but it will need more that an observation in one person to give any conclusive views.

A noticable tumor risk has yet to show itself but this is feasible, as is the case of any potent immunosuppressive agent.

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