Improvement of macular edema without discontinuation of fingolimod in a patient with multiple sclerosis

Akiyama, Hisanao; Suzuki, Yu; Hara, Daisuke; Shinohara, Kensuke; Ogura, Hana; Akamatsu, Masashi; Hasegawa, Yasuhiro

doi:10.1097/md.0000000000004180

Cited by 5 publications

(3 citation statements)

References 9 publications

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“…Our study found that FAME occurred mainly 3 m after the initiation of fingolimod, consistent with the phase III MS study and their extensions (14). However, a small proportion of patients develop late-onset ME (more than 12 months) (6,15,24,30,35), and blurred vision has also been reported as early as 24 h after initiation of the 0.5 mg dose (29). Patients with ME with diabetes or previous uveitis appear to develop it earlier.…”

Section: Discussionsupporting

confidence: 86%

Diagnosis and Management of Fingolimod-Associated Macular Edema

et al. 2022

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ObjectiveTo investigate the clinical features, treatment, and prognosis of fingolimod-associated macular edema (FAME) and to provide a reference for its rational management.MethodsFAME-related case reports were included in a pooled analysis by searching Chinese and English databases from 2010 to November 31, 2021.ResultsThe median age of 41 patients was 50 years (range, 21, 67 years), of whom 32 were women. The median time to onset of FAME was 3 m (range.03, 120), and blurred vision (17 cases) and decreased vision (13 cases) were the most common complaints. A total of 55 eyes were involved in FAME, including the left eye (14 cases), right eye (10 cases), and both eyes (15 cases), of which 46 eyes had best-corrected visual acuity close to normal (20/12-20/60) and 8 eyes had moderate to severe visual impairment (20/80-20/500). Fundus examination in 23 patients showed macular edema (11 cases). Optical coherence tomography (OCT) in 39 patients mainly showed perifoveal cysts (24 cases), ME (23 cases), and foveal thickening (19 cases). Fundus fluorescein angiography (FFA) in 18 patients showed vascular leakage (11 cases). Complete resolution of ME occurred in 50 eyes and recovery of visual acuity occurred in 45 eyes at a median time of 2 m (range 0.25, 24) after discontinuation of fingolimod or administration of topical therapy.ConclusionsMacular edema is a known complication of fingolimod. All patients using fingolimod require regular eye exams, especially those with a history of diabetes and uveitis and those undergoing cataract surgery.

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Section: Discussionsupporting

confidence: 86%

Diagnosis and Management of Fingolimod-Associated Macular Edema

et al. 2022

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“…Options include topical anti-inflammatory agents; sub-Tenon or intravitreal corticosteroids; oral acetazolamide, observation with close follow-up, or drug discontinuation. [370][371][372][373][374][375][376][377][378] Baseline screening examination before starting fingolimod followed by regular examinations is recommended as CME might develop after several years. 379…”

Section: Managementmentioning

confidence: 99%

The Impact of Systemic Medications on Retinal Function

Somisetty

Santina

Sarraf

et al. 2023

Asia-Pacific Journal of Ophthalmology

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This study will provide a thorough review of systemic (and select intravitreal) medications, along with illicit drugs that are capable of causing various patterns of retinal toxicity. The diagnosis is established by taking a thorough medication and drug history, and then by pattern recognition of the clinical retinal changes and multimodal imaging features. Examples of all of these types of toxicity will be thoroughly reviewed, including agents that cause retinal pigment epithelial disruption (hydroxychloroquine, thioridazine, pentosan polysulfate sodium, dideoxyinosine), retinal vascular occlusion (quinine, oral contraceptives), cystoid macular edema/retinal edema (nicotinic acid, sulfa-containing medications, taxels, glitazones), crystalline deposition (tamoxifen, canthaxanthin, methoxyflurane), uveitis, miscellaneous, and subjective visual symptoms (digoxin, sildenafil). The impact of newer chemotherapeutics and immunotherapeutics (tyrosine kinase inhibitor, mitogen-activated protein kinase kinase, checkpoint, anaplastic lymphoma kinase, extracellular signal-regulated kinase inhibitors, and others), will also be thoroughly reviewed. The mechanism of action will be explored in detail when known. When applicable, preventive measures will be discussed, and treatment will be reviewed. Illicit drugs (cannabinoids, cocaine, heroin, methamphetamine, alkyl nitrite), will also be reviewed in terms of the potential impact on retinal function.

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“…Incidence of FAME ranges from 0 to 2.08%; it occurs mainly during the first 3-4 months of therapy [13] and resolves spontaneously in the majority of patients after cessation of treatment. Oral administration of acetazolamide [14], non-steroidal anti-inflammatory drops [15] and intravitreal injection of steroid [16] have been also successfully used to treat macular oedema avoiding discontinuation of FTY [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Assessment of Macular Function by Multifocal Electroretinogram in Patients with Multiple Sclerosis Treated with Fingolimod

et al. 2021

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Introduction: This study aimed to evaluate whether treatment with fingolimod (FTY) may induce functional changes on the macular preganglionic retinal elements in patients affected by relapsing-remitting multiple sclerosis (RR-MS) without optic neuritis (ON). Methods: This case-control observational and retrospective study assessed multifocal electroretinogram (mfERG) responses from 35 healthy controls (mean age 43.58 ± 5.76 years), 41 patients with RR-MS without ON (mean age 40.64 ± 4.83 years, MS-noFTY group), and from 21 patients with RR-MS without ON (mean age 42.38 ± 12.34 years) and treated with fingolimod (GilenyaÒ, Novartis Europharm, 0.5 mg/day) (MS-FTY group). MfERG N1 and P1implicit times (ITs), and N1-P1 response amplitude densities (RADs) were measured from concentric rings (R) with increasing foveal eccentricity: 0-5°(R1), 5-10°(R2), 10-15°(R3), 15-20°(R4), 20-25°(R5). We considered R1 and R2 as ''central macular areas'' and R3, R4 and R5 as ''more eccentric retinal areas''. In the MS-FTY group, mfERG recordings were performed between 6 and 12 months (mean 7.2 ± 1.5 months) from the start of FTY. Results: In the MS-FTY group, the mean values of mfERG N1 and P1 ITs and RADs detected in both central macular areas (R1 and R2) and in more eccentric retinal areas (R3, R4 and R5) were not significantly different (p [ 0.01) with respect to those of control and MS-noFTY groups. Conclusions: Our mfERG results suggest that the chronic use of FTY does not induce a dysfunction of pre-ganglionic retinal elements located in the 0-25°of central retina. Since FTY does not cause any retinal functional abnormality, we suggest that FTY treatment could not produce any toxic effect on pre-ganglionic retinal elements even in the absence of macular oedema.Lucilla Barbano and Lucia Ziccardi equal contribution.

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Improvement of macular edema without discontinuation of fingolimod in a patient with multiple sclerosis

Cited by 5 publications

References 9 publications

Diagnosis and Management of Fingolimod-Associated Macular Edema

Diagnosis and Management of Fingolimod-Associated Macular Edema

The Impact of Systemic Medications on Retinal Function

Assessment of Macular Function by Multifocal Electroretinogram in Patients with Multiple Sclerosis Treated with Fingolimod

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