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Multiple sclerosis treatment with fingolimod: profile of non-cardiologic adverse events

Abstract

Fingolimod was the first oral medication approved for management of multiple sclerosis and is currently used by tens of thousands patients worldwide. Fingolimod acts via the sphingosine 1-phosphate (S1P) receptor, maintaining peripheral lymphocytes entrapped in the lymph nodes. In consequence, there is a reduction in the infiltration of aggressive lymphocytes into the central nervous system. The drug is safe and effective, and its first hours of use are associated with related to S1P receptors in the heart. This side effect is well known by all doctors prescribing fingolimod. However, the drug has other potential adverse events that, although relatively rare, require awareness from the neurologist. Among these there are infections (herpes simplex, herpes zoster, Cryptococcus, Epstein–Barr virus, hepatitis, Molluscum Contagiosum, and leishmaniosis), lung and thyroid complications, refractory headaches, encephalopathy, vasculopathy, tumefactive lesions in magnetic resonance imaging and ophthalmological disorders. The present review lists the non-cardiologic adverse events that all neurologists prescribing fingolimod should be aware of.

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Correspondence to Yara Dadalti Fragoso.

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The author has no conflicts of interest to declare related to this work. The author has received support for participation in congresses and has been a medical education speaker for Teva Pharmaceuticas, Novartis, Merck-Serono, Biogen-Idec, Bayer-Schering.

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This work was carried out without private or public funding. The author has no financial agreement with Novartis, the company that developed and commercializes fingolimod (Gilenya®).

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Fragoso, Y.D. Multiple sclerosis treatment with fingolimod: profile of non-cardiologic adverse events. Acta Neurol Belg 117, 821–827 (2017). https://doi.org/10.1007/s13760-017-0794-7

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Keywords

  • Multiple sclerosis
  • Fingolimod
  • Adverse events
  • Herpes
  • Cryptococcus
  • Macular edema