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Area of Science:

  • Neurology
  • Immunology
  • Pharmacology

Background:

  • Natalizumab and fingolimod are disease-modifying therapies (DMTs) for highly active relapsing-remitting multiple sclerosis (RRMS).
  • Fingolimod has demonstrated efficacy in reducing relapse rates and MRI lesions compared to interferon beta or placebo.
  • Head-to-head trials comparing fingolimod and natalizumab are lacking, with natalizumab having more extensive clinical experience.

Observation:

  • A case study of a 31-year-old woman with RRMS who experienced severe side effects from natalizumab.
  • Following a treatment-free period and a severe relapse managed with prednisone and plasmapheresis, fingolimod was initiated.
  • Spectacular improvements in MRI signs were observed in the months following fingolimod initiation.

Findings:

  • Fingolimod treatment led to significant improvement in MRI outcomes in a patient with highly active RRMS.
  • The observed MRI improvements occurred after the patient discontinued natalizumab due to side effects and experienced a severe relapse.

Implications:

  • Fingolimod may serve as a valuable alternative to natalizumab for RRMS patients with advanced disease or intolerance to natalizumab.
  • This case suggests fingolimod's potential utility in managing highly active RRMS, even after severe relapses or cessation of natalizumab therapy.