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Clinical exacerbation of SARS-CoV2 infection after fingolimod withdrawal

Victor Gomez-Mayordomo1, Paloma Montero-Escribano1, Jordi A Matías-Guiu1

  • 1Department of Neurology, Institute of Neurosciences, San Carlos Health Research Institute (IdISSC), Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain.

Journal of Medical Virology
|July 10, 2020
PubMed

Insights

Discontinuing fingolimod during COVID-19 may worsen SARS-CoV-2 infection in multiple sclerosis patients. This immune therapy withdrawal can lead to hyperinflammation, suggesting careful management is needed.

Area of Science:

  • Immunology
  • Neurology
  • Infectious Diseases

Background:

  • The role of disease-modifying therapies (DMTs) in autoimmune disorders during SARS-CoV-2 infection is debated.
  • Immunocompromised patients may experience severe COVID-19 due to inadequate immune response.
  • Immune-modulating therapies might offer protection by reducing cytokine-release syndrome.

Observation:

  • Fingolimod, an immune therapy for multiple sclerosis (MS), sequesters lymphocytes.
  • A 57-year-old MS patient on fingolimod experienced COVID-19 reactivation with hyperinflammation after drug withdrawal.
  • This case highlights a potential link between fingolimod discontinuation and COVID-19 severity.

Findings:

  • Fingolimod withdrawal in an MS patient correlated with SARS-CoV-2 reactivation and hyperinflammation.
  • The patient's condition worsened upon stopping fingolimod treatment.
  • This suggests fingolimod may play a role in managing SARS-CoV-2 infection in MS patients.

Implications:

  • Discontinuation of fingolimod during COVID-19 infection may exacerbate SARS-CoV-2 disease.
  • Careful consideration of DMT management is crucial for MS patients during the COVID-19 pandemic.
  • Further research is needed to understand the complex interplay between MS therapies and viral infections.
Keywords:
COVID-19SARS-CoV-2coronavirusexacerbationfingolimodmultiple sclerosis

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