Two-year macular volume assessment in multiple sclerosis patients treated with fingolimod

Abstract

Background Fingolimod (FNG) is associated with the development of symptomatic macular edema (ME) in a small subset of multiple sclerosis (MS) patients. By using spectral domain optical coherence tomography (SD-OCT), an increase in the total macular volume (TMV) was rarely detected during the first months of treatment.Objectives The objective of this study is to assess whether FNG treatment leads to long-term macular changes in a real-life setting. Methods Sixty RRMS patients starting FNG, according to therapeutic indication, were enrolled at three Italian MS centers and followed for 2 years. Results The mean TMV did not change between baseline and the follow-up. No patients experienced visual acuity drop during the follow-up. Conclusions Initiation of FNG in MS is associated with a modest, not significant, increase in macular volume followed by no further significant changes over 2 years, highlighting the good safety profile of such treatment in MS.

Fingolimod and Diabetic Retinopathy: A Drug Repurposing Study

“…Fingolimod was able to exert an anti-inflammatory action and to increase blood retinal barrier tight junctions expression in a rodent model of DR, by ultimately reducing vascular permeability (Fan and Yan, 2016). To this regard, it is worthy of note that the examination of fingolimod ocular effects in RR-MS patients showed a preserved macular structure and thickness over the time, together with a complete absence of macular edema, even if it is reported as a fingolimod side effect (Fruschelli et al, 2019;d'Ambrosio et al, 2020;Rossi et al, 2020). In our study, a virtual screening approach evidenced that fingolimod, along with other FDA already approved drugs, can bind with good-predicted affinity to melanocortin receptors MC1R and MC5R.…”

“…Moreover, fingolimod was able to reduce vascular permeability, increasing tight junctions expression in the blood retinal barrier (Fan and Yan, 2016). Additionally, several studies reported a preserved macular structure and thickness over time in RR-MS patients treated with fingolimod (Fruschelli et al, 2019;d'Ambrosio et al, 2020). Worthy of note, although macular edema is reported as a side effect of fingolimod administration with an incidence of 0.3-1.2% (Nolan et al, 2013), two studies evidenced that RR-MS patients treated with fingolimod did not show any case of macular edema (Fruschelli et al, 2019;Rossi et al, 2020).…”

Retinal imaging with optical coherence tomography in multiple sclerosis: novel aspects

“…The incidence for macular edema in real-life settings is about 1%, with good clinical outcomes after discontinuation of the medication [ 74 ]. Moreover, fingolimod mildly increases total macular volume in the general population [ 75 , 76 ].…”