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Rev Neurol. 2012 Aug 16;55(4):227-37.

[Infections and fingolimod].

[Article in Spanish]

Author information

1
Hospital Clinic de Barcelona, 08036 Barcelona, Espana. ccervera@clinic.ub.es

Abstract

INTRODUCTION:

Fingolimod is the first approved drug with oral availability for the treatment of relapsing multiple sclerosis.

AIMS:

To review the mechanism of action of fingolimod and its relationship with the development of infections. To propose preventive measures for those patients who are receiving the drug or will initiate a new treatment. In addition, the role of fingolimod in the development of progressive multifocal leukoencephalopathy on the basis of recent knowledge of its pathophysiology will be discussed.

DEVELOPMENT:

The mechanism of action of fingolimod is based on an antagonic effect on the sphingosine 1-phospate receptors that will generate an inhibition of the egress of naive and central memory lymphocytes into the bloodstream, allowing the free recirculation of memory effectors T lymphocytes. This effect will produce lymphopenia. Fingolimod-associated lymphopenia is a consequence of lymphocyte redistribution, and it is selective and reversible. There is no evidence of higher number of opportunistic and non-opportunistic infections in comparison to placebo or interferon beta-1a in patients receiving fingolimod. However, two patients developed severe herpetic infections under fingolimod.

CONCLUSIONS:

Fingolimod induce a selective and reversible lymphopenia that, taking into account the most recent available data, does not seem to be associated with higher risk of opportunistic infections due to a preservation of immuno-surveillance. The risk of herpesvirus infection should be taken into consideration and more studies are warranted to confirm if an association of these infections with the use of fingolimod exists.

PMID:
22829086
[Indexed for MEDLINE]
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