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Arch Neurol. 2012 Feb;69(2):262-4. doi: 10.1001/archneurol.2011.1057.

Rebound of disease activity after withdrawal of fingolimod (FTY720) treatment.

Author information

1
Institute of Clinical Neuroimmunology, Ludwig-Maximilians-University, Marchioninistr 15, 81377 Munich, Germany.

Abstract

BACKGROUND:

The oral sphingosine-1-phosphate receptor modulator fingolimod (FTY720) 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.

DESIGN:

Case report and review of literature.

SETTING:

Institute of Clinical Neuroimmunology, Ludwig-Maximilians-University, Munich, Germany.

PATIENT:

A 45-year-old man diagnosed as having relapsing-remitting multiple sclerosis.

MAIN OUTCOME MEASURES:

Multiple sclerosis disease activity including annual relapse rate, Expanded Disability Status Scale score, and number of gadolinium-enhancing lesions on magnetic resonance imaging before, during, and after treatment with fingolimod.

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 (>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.

PMID:
22332194
DOI:
10.1001/archneurol.2011.1057
[Indexed for MEDLINE]

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