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Fingolimod for Multiple Sclerosis
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Journal Article
Fingolimod for Multiple Sclerosis
2012
Overview
A 37-year-old man with multiple sclerosis has recurrent disease activity despite several previous therapies. Treatment with fingolimod is recommended. Fingolimod blocks the egress of lymphocytes from lymph nodes, preventing them from reaching the central nervous system.
Foreword
This
Journal
feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are reviewed. Relevant formal guidelines, if they exist, are presented. The article ends with the authors' clinical recommendations.
Stage
A 37-year-old man with multiple sclerosis was evaluated for consideration of oral immunotherapy. Six years earlier, he had reported acute monocular visual disturbance. The diagnosis of multiple sclerosis was subsequently confirmed by means of examination of cerebrospinal fluid, which revealed an increased IgG index and oligoclonal banding, and by abnormal results on magnetic resonance imaging (MRI). There was no family history of multiple sclerosis. Daily injections of glatiramer acetate were initiated at the time of diagnosis, but two consecutive annual brain MRI scans revealed substantial disease activity. He was then switched to interferon beta therapy, but this treatment was . . .
Publisher
Massachusetts Medical Society
Subject
/ Biological and medical sciences
/ Central Nervous System - drug effects
/ Disease
/ Humans
/ Immunosuppressive Agents - adverse effects
/ Immunosuppressive Agents - pharmacology
/ Immunosuppressive Agents - therapeutic use
/ Male
/ Multiple Sclerosis - drug therapy
/ Multiple Sclerosis - physiopathology
/ Patients
/ Propylene Glycols - adverse effects
/ Propylene Glycols - pharmacology
/ Propylene Glycols - therapeutic use
/ Sphingosine - adverse effects
