Multiple sclerosis reactivation postfingolimod cessation: Is it IRIS?

Alroughani, Raed; Almulla, Ahmad; Lamdhade, S.; Thussu, A

doi:10.1136/bcr-2014-206314

Cited by 23 publications

(13 citation statements)

References 22 publications

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“…Reported cases of unexpected increases in clinical and MRI activity after discontinuation of fingolimod began accumulating in 2012 [10,[25][26][27][28][29][30][31][32][33][34][35], with some including reports of tumefactive lesions on MRI [36][37][38][39][40]. While these cases exhibit a significant amount of clinical heterogeneity, a recently published case series has demonstrated three different MRI patterns of post-fingolimod rebound: tumefactive lesions, a punctated pattern with innumerable small T2 and gadolinium (Gd)enhancing lesions, and a pattern more typical of classical MS [40].…”

Section: Reports Of Disease Rebound After Fingolimod Discontinuationmentioning

confidence: 99%

Fingolimod Rebound: A Review of the Clinical Experience and Management Considerations

et al. 2019

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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.

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Section: Reports Of Disease Rebound After Fingolimod Discontinuationmentioning

confidence: 99%

Fingolimod Rebound: A Review of the Clinical Experience and Management Considerations

et al. 2019

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“…Некоторые авторы обращают внимание на возможность развития опухолеподобной симптомати-ки на фоне отмены Ф [113,120]. Иногда клинические и радиологические проявления имеют сходство с ПМЛ [121]. Описаны случаи развития ПМЛ-ВСВИ у пациентов, которых перевели с терапии НТМ на терапию Ф [66,122].…”

Section: финголимодunclassified

“…Описаны случаи развития ПМЛ-ВСВИ у пациентов, которых перевели с терапии НТМ на терапию Ф [66,122]. Многие авторы отмечают рефрактерность рикошетных обострений к стероидам [104,112,116,119,121].…”

Section: финголимодunclassified

“…Механизм развития ребаунд-синдрома при отмене Ф связывают с массивным выходом аутоагрессивных лимфоцитов из лимфоузлов после отмены Ф и быстрым увеличением их содержания в ЦСЖ и головном мозге [118,120,121]. Е.В.…”

Section: финголимодunclassified

“…Многие исследователи указывают, что явления, лежащие в основе феномена рикошета, по сути представляют собой ВСВИ, и использование этого термина вполне уместно для описания чрезмерного ответа не только на экзогенные (инфекция), но и на эндогенные (неинфекционные) антигены [8,111,120,121]. Некоторые авторы, основываясь на положительном эффекте иммуноадсорбции в терапии ребаунд-синдрома, указывают на возможную роль нарушений гуморального иммунитета в патогензе гормонустойчивого ребаунд-синдрома, развившегося при отмене Ф [112].…”

Section: финголимодunclassified

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Immune reconstitution inflammatory syndrome and rebound syndrome in multiple sclerosis patients who stopped disease modification therapy: current understanding and a case report

Белова

Rasteryaeva

Zhulina

et al. 2017

Z. nevrol. psikhiatr. im. S.S. Korsakova

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More and more multiple sclerosis patients have been receiving treatment with new immunomodulatory drugs. Its discontinuation because of side-effects, lack of efficacy or pregnancy has been increasing as well. This paper reviews such severe complications of natalizumab and fingolimod cessation as immune reconstitution inflammatory syndrome (IRIS) and rebound. The short history, immunopathogenesis and diagnostic criteria of IRIS in individuals with human immunodeficiency virus infection are covered. Clinical and radiological presentations as well as possible pathogenic mechanisms of IRIS in patients treated with natalizumab and fingolimod are discussed. The authors also report the case of a woman with multiple sclerosis treated with fingolimod, who experienced a severe relapse when she stopped treatment. Diagnostic criteria and prognostic factors for IRIS and rebound are needed in patients with multiple sclerosis who discontinue the new disease modification therapy.

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Abuse and dependence potential of sphingosine-1-phosphate (S1P) receptor modulators used in the treatment of multiple sclerosis: a review of literature and public data

Schoedel¹,

Kolly

Gardin

et al. 2021

Psychopharmacology

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Abuse and misuse of prescription drugs remains an ongoing concern in the USA and worldwide; thus, all centrally active new drugs must be assessed for abuse and dependence potential. Sphingosine-1-phosphate (S1P) receptor modulators are used primarily in the treatment of multiple sclerosis. Among the new S1P receptor modulators, siponimod, ozanimod, and ponesimod have recently been approved in the USA, European Union (EU), and other countries. This review of literature and other public data has been undertaken to assess the potential for abuse of S1P receptor modulators, including ozanimod, siponimod, ponesimod, and fingolimod, as well as several similar compounds in development. The S1P receptor modulators have not shown chemical or pharmacological similarity to known drugs of abuse; have not shown abuse or dependence potential in animal models for subjective effects, reinforcement, or physical dependence; and do not have adverse event profiles demonstrating effects of interest to individuals who abuse drugs (such as sedative, stimulant, mood-elevating, or hallucinogenic effects). In addition, no reports of actual abuse, misuse, or dependence were identified in the scientific literature for fingolimod, which has been on the market since 2010 (USA) and 2011 (EU). Overall, the data suggest that S1P receptor modulators are not associated with significant potential for abuse or dependence, consistent with their unscheduled status in the USA and internationally.

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Multiple sclerosis reactivation postfingolimod cessation: Is it IRIS?

Cited by 23 publications

References 22 publications

Fingolimod Rebound: A Review of the Clinical Experience and Management Considerations

Fingolimod Rebound: A Review of the Clinical Experience and Management Considerations

Immune reconstitution inflammatory syndrome and rebound syndrome in multiple sclerosis patients who stopped disease modification therapy: current understanding and a case report

Abuse and dependence potential of sphingosine-1-phosphate (S1P) receptor modulators used in the treatment of multiple sclerosis: a review of literature and public data

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