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Effectiveness of alternative dose fingolimod for multiple sclerosis

Erin E Longbrake1, Daniel Kantor1, Siddharama Pawate1

  • 1Yale University (EEL), New Haven, CT; Medical Partnership 4 MS (MP4MS) (DK), Coconut Creek, FL; Vanderbilt University (SP, MJB), Nashville, TN; University of Washington (GvG), Seattle; Washington University (SC, AHC, BJP), St. Louis, MO; MS Center of Tidewater (MR), Norfolk, VA; Nehme & Therese Tohme MS Center (SJK, BY, MZ), Beirut, Lebanon; RWJ Barnabas Health (SR-G, IK), West Orange, NJ; C/Fuentes Claras 1 (AC-R), Avila, Spain; MS Center of Northeastern NY (KE), Latham; Elliot Lewis Center for MS Care (EL), Wellesley, MA; Spectrum Health Medical Group (DV), Grand Rapids, MI; University of Alabama (WM), Birmingham; University of Southern California (RB), Los Angeles; and NYU Langone Health (LG, TEB, IK), New York, NY.

Neurology. Clinical Practice
|May 1, 2018
PubMed
Abstract

Insights

Alternate fingolimod dosing maintains similar disease control as daily dosing for relapsing multiple sclerosis (MS) patients experiencing adverse events. This strategy supports managing MS with profound lymphopenia or other side effects.

Area of Science:

  • Neurology
  • Immunology
  • Pharmacology

Background:

  • Fingolimod is an oral medication for relapsing multiple sclerosis (MS).
  • Clinicians may use less frequent dosing due to adverse events like lymphopenia.
  • Limited data exist on alternate fingolimod dosing effectiveness.

Purpose of the Study:

  • To evaluate the effectiveness of alternate-dose fingolimod in MS patients.
  • To compare clinical and radiologic outcomes between daily and alternate fingolimod dosing.

Main Methods:

  • Multicenter, retrospective, observational study.
  • 170 MS patients on alternate fingolimod doses for ≥1 month.
  • Comparison of outcomes during daily vs. alternate dosing.

Main Results:

  • Common reasons for alternate dosing: lymphopenia (77%), liver abnormalities (9%), infections (7%).
  • Similar disease activity: annualized relapse rate (0.1 vs. 0.2), contrast-enhancing lesions (7.6% vs. 9.4%).
  • Prior contrast-enhancing lesions predicted breakthrough disease on alternate dosing (OR 11.4, p < 0.001).

Conclusions:

  • Alternate fingolimod dosing is a viable strategy for MS patients with adverse events.
  • Supports managing patients with profound lymphopenia or other side effects.
  • Class IV evidence suggests similar disease activity compared to daily dosing.

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