Fingolimod Associated Bilateral Cystoid Macular Edema—Wait and See?

Abstract

Fingolimod 0.5-mg once-daily is an approved therapy for patients with relapsing–remitting multiple sclerosis (MS). Several pivotal and real-world studies have demonstrated that fingolimod is associated with the development of macular edema (ME). Herein, we present a case of a diabetic MS patient who developed severe bilateral ME during fingolimod treatment. By means of this case study we provide a detailed review about fingolimod associated macular edema (FAME), its current incidence with or without diabetes mellitus, and previous therapy attempts and outcomes in MS patients. Intravitreal administration of antibodies raised against vascular endothelial growth factor A (VEGF-A) has not yet been used in the management of FAME, however, the excellent therapeutic response in our patient may justify the use of anti-VEGF-A agents in combination with cessation of fingolimod to achieve fast resolution of FAME and to prevent visual deficits, particularly in bilateral FAME.

Maraviroc inhibits SARS-CoV-2 multiplication and s-protein mediated cell fusion in cell culture

“…In the set of compounds that influenced host signaling and inflammatory events, FTY-720 showed a 38.4-fold decrease (p<0.0001) of SARS-CoV-2 viral titer as compared to the DMSO control. FTY-720 is FDA-approved for the treatment of multiple sclerosis and is documented to exhibit anti-inflammatory activities by modulating the NFkB signaling cascade (Pul et al, 2016). In this class of compounds, Atorvastatin, a commonly used statin for the treatment of high cholesterol, was noted to decrease viral load 1.6-fold (p<0.01) as compared to the DMSO control.…”

“…FTY720 treatment may produce short term fluctuations in cardiovascular parameters and blood pressure due to agonistic and antagonistic impacts on Sphingosine-1-phosphate receptor (S1PR) which is differentially expressed in tissues including cardiac cells (Camm et al, 2014). FTY720 has also been implicated in cases of Fingolimod associated macular edema, especially when administered in the same regimen as for multiple sclerosis (Pul et al, 2016). These factors will require consideration if FTY720 is to be evaluated for COVID-19 treatment.…”

Efficacy and Safety of Etrasimod in a Phase 2 Randomized Trial of Patients With Ulcerative Colitis

“…9,14 This lack of selectivity has been suggested to contribute to some of the adverse events (AEs) observed in patients treated with fingolimod, including pulmonary fibrosis and elevation of liver enzymes. 14,16,29 Fingolimod has also been associated with macular edema, 30 which is likely partially due to an S1P 1 effect that is exacerbated by S1P 2 and S1P 3 31 and with postmarketing cases of progressive multifocal leukoencephalopathy in patients with multiple sclerosis. 32,33 Newer S1P receptor modulators with selective receptor isoform affinities are currently in development.…”

Loratadine-associated cystoid macular edema: A case report

“…Drug-induced CME can be caused by various drugs such as taxanes, 4 acitretin 5 , tamoxifen, 6 niacin 7 , interferon, fingolimod, 8 prostaglandin, epinephrine, and timolol among others. 9 However, systemic anti-histamines- or anti-histamine eye drops-induced CME has not yet been reported.…”