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Review
. 2019 Dec;8(2):241-250.
doi: 10.1007/s40120-019-00160-9. Epub 2019 Nov 1.

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

Brian Barry  1 , April A Erwin  2 , Jessica Stevens  1 , Carlo Tornatore  3
Affiliations
Review

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

Brian Barry et al. Neurol Ther. 2019 Dec.

Abstract

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.

Keywords: Disease-modifying therapy; Fingolimod; Multiple sclerosis; Rebound; Relapse.

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Conflict of interest statement

April A. Erwin has served as a speaker and advisory board member for Biogen, Celgene, EMD-Serono, Genentech, Novartis, and Sanofi-Genzyme. Carlo Tornatore has served as a speaker and advisory board member for Biogen and Novartis. Brian Barry and Jessica Stevens have nothing to disclose.

Figures

Fig. 1
Fig. 1
Proposed treatment algorithm for fingolimod rebound
See this image and copyright information in PMC

References

    1. Berkovich R. Treatment of acute relapses in multiple sclerosis. Neurotherapeutics. 2013;10(1):97–105. doi: 10.1007/s13311-012-0160-7. - DOI - PMC - PubMed
    1. Lublin F, Baier M, Cutter G. Effect of relapses on development of residual deficit in multiple sclerosis. Neurology. 2003;61(11):1528–1532. doi: 10.1212/01.WNL.0000096175.39831.21. - DOI - PubMed
    1. Lassmann H, Bruck W, Lucchinetti C. The immunopathology of multiple sclerosis: an overview. Brain Pathol. 2007;17(2):210–218. doi: 10.1111/j.1750-3639.2007.00064.x. - DOI - PMC - PubMed
    1. Frischer J, Weigand S, Guo Y, et al. Clinical and pathological insights into the dynamic nature of the white matter multiple sclerosis plaque. Ann Neurol. 2015;78(5):710–721. doi: 10.1002/ana.24497. - DOI - PMC - PubMed
    1. Berkovich R. Clinical and MRI outcomes after stopping or switching disease-modifying therapy in stable MS patients: a case series report. Mult Scler Relat Disord. 2017;17:123–127. doi: 10.1016/j.msard.2017.07.007. - DOI - PubMed

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