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Multiple Sclerosis l: Introduction01:19

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Multiple sclerosis is a chronic autoimmune disease of the central nervous system (CNS) that affects the brain, spinal cord, and optic nerves. It is an inflammatory demyelinating disorder and a leading cause of neurological disability in young adults.EpidemiologyMS commonly begins between 20 and 40 years of age and is twice as common in women. Its exact cause remains unclear, but genetic susceptibility contributes, with higher risk in first-degree relatives and identical twins. A greater...
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Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel...
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[Fingolimod treatment in multiple sclerosis].

Masami Tanaka

    Nihon Rinsho. Japanese Journal of Clinical Medicine
    |December 19, 2014
    PubMed
    Summary

    Fingolimod, an oral therapy for relapsing-remitting multiple sclerosis (RRMS), reduces relapses and brain atrophy by trapping lymphocytes. Dosage adjustments are proposed for patients with low lymphocyte counts to mitigate adverse effects.

    Area of Science:

    • Neuroimmunology
    • Pharmacology

    Context:

    • Multiple sclerosis (MS) is a central nervous system inflammatory disorder with a relapsing-remitting (RR) course.
    • Fingolimod is the first oral disease-modifying therapy approved for RRMS, functioning by modulating lymphocyte trafficking.

    Purpose:

    • To review the mechanism of action, efficacy, and safety of fingolimod in RRMS.
    • To propose specific indications and dosage adjustments for fingolimod therapy based on lymphocyte counts.

    Summary:

    • Fingolimod acts as a sphingosine-1-phosphate receptor 1 (S1P1) functional antagonist, preventing lymphocyte egress from lymph nodes and reducing circulating lymphocyte counts.
    • Clinical efficacy includes reduced relapses, suppressed MRI-detected enhancing lesions, and slowed brain atrophy progression.
    • Adverse effects include bradycardia, infections (e.g., herpes zoster), macular edema, liver dysfunction, and teratogenicity.

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    Impact:

    • Fingolimod offers an oral treatment option for RRMS, improving clinical outcomes and MRI-defined disease activity.
    • Understanding its mechanism and side effect profile allows for optimized patient selection and therapeutic management, including proposed dose reductions for lymphopenic patients.