What happens after fingolimod discontinuation? A multicentre real-life experience
| Autor: | Eleonora Cocco, Maria Cellerino, Carolina Gabri Nicoletti, Girolama Alessandra Marfia, Marta Ponzano, Marzia Fronza, Giacomo Boffa, Maria Elena Ricchiuto, Elisabetta Mancuso, Jessica Frau, Doriana Landi, Giuseppe Fenu, Matilde Inglese, Alessio Signori |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
medicine.medical_specialty Multiple Sclerosis Neurology Discontinuation Relapsing-Remitting Settore MED/26 Logistic regression 03 medical and health sciences Multiple Sclerosis Relapsing-Remitting 0302 clinical medicine Internal medicine Humans Medicine 030212 general & internal medicine Risk factor Expanded Disability Status Scale Fingolimod Hydrochloride business.industry Multiple sclerosis Fingolimod Reactivation medicine.disease Magnetic Resonance Imaging Lymphocyte count Cohort Female Neurology (clinical) business Immunosuppressive Agents 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Journal of Neurology. 269:796-804 |
| ISSN: | 1432-1459 0340-5354 |
| Popis: | To analyse the course of multiple sclerosis (MS) after fingolimod withdrawal in a multicentre cohort. Patients who discontinued fingolimod were included. Relapses, Expanded Disability Status Scale (EDSS), and new/gadolinium-enhancing lesions on magnetic resonance imaging (MRI) were assessed during the last year on fingolimod, and in the year after discontinuation. Wilcoxon test was used to analyse the difference in EDSS and relapses between the two periods, and to compare lymphocyte counts at discontinuation and 3 months later. Demographic and clinical variables were evaluated using univariable and multivariable logistic regression analyses. Patients were 230 (females 66.1%; mean age 38 years; median EDSS 3). Fingolimod was discontinued due to inefficacy in 57%, and 87.4% started another treatment. Relapse was observed in 33% of the patients in the year after discontinuation. Severe reactivation was observed in 15%. During the first 6 months after discontinuation, new/enhancing lesions were seen in 62/116 patients. Higher age at the fingolimod discontinuation was found to be associated with a lower probability of inflammatory activity (p = 0.001) and severe reactivation (p = 0.007) during the year after discontinuation. Lower lymphocyte count was a risk factor for clinical, radiological, and severe activity (p = 0.02, p = 0.002, p = 0.01, respectively). The main reason for the discontinuation of fingolimod was inefficacy. One-third of the patients had a relapse during the year after discontinuation, 15% experienced a severe reactivation, and approximately 50% of patients with available MRI scan had new/enhancing lesions. The risk factors for disease activity after discontinuation were low lymphocyte count and younger age. |
| Databáze: | OpenAIRE |
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