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Review
. 2023 Jul 31;23(1):286.
doi: 10.1186/s12883-023-03333-0.

Macular edema after siponimod treatment for multiple sclerosis: a case report and literature review

Qingsheng Li  1   2 , Li-Jun Jing  1 , Yanfei Li  1 , Yanjie Jia  3
Affiliations
Review

Macular edema after siponimod treatment for multiple sclerosis: a case report and literature review

Qingsheng Li et al. BMC Neurol. .

Abstract

Background: As a modulator of the sphingosine 1-phosphate receptor, siponimod is administered as a therapeutic intervention for multiple sclerosis. A previous phase 3 study first reported siponimod-associated macular edema. Since that report, there were only few relevant reports in clinical settings. Here, we report a case of secondary progressive multiple sclerosis developed macular edema after siponimod treatment. We also review the progress of sphingosine 1-phosphate receptor modulators, elaborate on accepted mechanisms in treating multiple sclerosis, and discuss the causation of siponimod-associated macular edema.

Case presentation: A 38-year-old Chinese female patient with secondary progressive multiple sclerosis, who had recurrent numbness of the limbs and right leg fatigue, developed mild macular edema following 4 months of siponimod treatment. The macular edema resolved after discontinuing the medication, and did not recur after resuming siponimod.

Conclusion: Although siponimod-associated macular edema may be rare, mild, transitory, and manageable, it cannot be ignored and requires ongoing vigilance.

Keywords: Case report; Macular edema; Multiple sclerosis; Siponimod; Sphingosine 1-phosphate.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Brain MRI (T2-FLAIR) performed in November 2021 shows multiple hyperintense white matter lesions adjacent to the bilateral ventricle, at the bilateral frontal lobe, and at the right centrum semiovale and venous developmental anomaly at the left frontal lobe (A–C). DWI shows no abnormalities. Axial cervical (T2) and thoracic (T2-FS) spinal MRI present multiple hyperintense patchy lesions along the cervical and thoracic segments (D–F). Sagittal MRI (T2–FS) shows banded lesions along the thoracic and cervical cord at the C4–C6 and T2–T9 levels (G, H). Strong signals are not present on enhancing MRI. Red arrowheads indicate the lesions. DWI, diffusion-weighted imaging; MRI, magnetic resonance imaging; T2, T2-weighted imaging; T2-FLAIR, T2-weighted fluid-attenuated inversion recovery imaging; T2-FS, fat-saturated T2-weighted imaging
Fig. 2
Fig. 2
OCT images. The left (A) and right eyes (B) exhibit mild macular edema after 4 months of siponimod therapy. One month after withdrawal of siponimod, OCT shows resolution of left macular edema (C) and alleviation of right eye lesions (D). OCT, optical coherence tomography
Fig. 3
Fig. 3
Disease course. OCT, optical coherence tomography; RRMS, relapsing-remitting multiple sclerosis
See this image and copyright information in PMC

References

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