Acute Anterior Uveitis in a Patient Taking Fingolimod (FTY720) for Multiple Sclerosis

Fingolimod is an oral sphingosine-1-phosphate (S1P) receptor modulator and the first oral therapy for relapsing-remitting multiple sclerosis. Its use has been complicated by a low rate of cystoid macular edema usually in the first 3 months after commencement of the medication. We report the case of a 34-year-old male with relapsing-remitting multiple sclerosis, who developed acute anterior uveitis on day 5 of fingolimod treatment. He responded to appropriate treatment and cessation of drug, but developed low-grade chronic anterior uveitis without cystoid macular edema. We discuss possible mechanisms of uveitis onset in this group of patients. Urgent ophthalmological review is recommended for patients receiving fingolimod therapy who develop a red, painful eye, which may occur within 5 days of fingolimod treatment initiation.

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REALMS study: real-world effectiveness and safety of fingolimod in patients with relapsing-remitting multiple sclerosis in Portugal

Neurological Sciences ◽

10.1007/s10072-020-04726-6 ◽

2020 ◽

Author(s):

S. Batista ◽

C. C. Nunes ◽

J. J. Cerqueira ◽

Ana Martins Silva ◽

J. Correia de Sá ◽

...

Keyword(s):

Multiple Sclerosis ◽

Real World ◽

Previous Treatment ◽

Disease Evolution ◽

Safety Issues ◽

Receptor Modulator ◽

Study Results ◽

Relapsing Remitting ◽

Remitting Multiple Sclerosis ◽

Relapsing Remitting Multiple Sclerosis

Abstract Background Fingolimod, an oral sphingosine 1-phosphate receptor modulator, is approved by EMA for relapsing-remitting multiple sclerosis (RRMS). Objectives To assess the effectiveness and safety of fingolimod in patients with RRMS in real-world clinical practice in Portugal. Methods Retrospective, multicentre, non-interventional study, reporting 3 years follow-up of data collected from October 2015 to July 2016. Sociodemographic data and previous treatments at baseline and data regarding disease evolution, including number of relapses, annualised relapse rates (ARR) and Expanded Disability Status Scale (EDSS), were collected. Results Two-hundred and seventy-five participants were enrolled in the REALMS study. Results showed that the main reason to switch to fingolimod was failure of previous treatment (56.7%) and only 3.6% were naïve patients. In the total population, there was a significant decrease in ARR of 64.6% in the first year of treatment, 79.7% in the second year and 82.3% in the third year, compared with baseline. More than 67.0% of patients had no relapses during the 3 years after switching to fingolimod. EDSS remained stable throughout the study. Conclusions Therapy with fingolimod showed a sustained effectiveness and safety over the 3 years, particularly on patients switched from first-line drugs (BRACE). No new safety issues were reported.

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Rapid Progression of Low-Grade Cervical Dysplasia into Invasive Cancer during Natalizumab Treatment for Relapsing Remitting Multiple Sclerosis

Case Reports in Oncology ◽

10.1159/000496198 ◽

2019 ◽

Vol 12 (1) ◽

pp. 59-62

Author(s):

King Man Wan ◽

Martin K. Oehler

Keyword(s):

Multiple Sclerosis ◽

Cervical Screening ◽

Cervical Dysplasia ◽

Pelvic Lymphadenectomy ◽

Rapid Progression ◽

Low Grade ◽

Increased Risk ◽

Relapsing Remitting ◽

Remitting Multiple Sclerosis ◽

Relapsing Remitting Multiple Sclerosis

A 25-year-old patient treated for relapsing remitting multiple sclerosis (RRMS) with natalizumab had a rapid progression of a low grade squamous intraepithelial lesion to a FIGO stage 1B1 squamous cell carcinoma of the uterine cervix within 2 years. She was treated with radical hysterectomy and pelvic lymphadenectomy and subsequently developed a vault recurrence within 2 years. The recurrence was treated with definitive synchronous chemo-radiotherapy and she has been disease free for 7 years. This case and existing evidence on increased risk of developing cervical dysplasia under natalizumab show that MS patients under immunosuppressive therapy require close annual cervical screening with immediate investigation of abnormal test results.

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Diagnostic Dilemma: An Atypical Case of Astrocytoma in a Patient with Relapsing–Remitting Multiple Sclerosis

Neurology International ◽

10.3390/neurolint13020025 ◽

2021 ◽

Vol 13 (2) ◽

pp. 240-251

Author(s):

Chantal Kahovec ◽

Aman Saini ◽

Michael C. Levin

Keyword(s):

Multiple Sclerosis ◽

Magnetic Resonance ◽

Brain Tumors ◽

Resonance Spectroscopy ◽

Low Grade ◽

Relapsing Remitting ◽

Mri Scans ◽

Remitting Multiple Sclerosis ◽

Relapsing Remitting Multiple Sclerosis ◽

Progressive Course

Distinguishing between tumefactive demyelinating lesions (TDLs) and brain tumors in multiple sclerosis (MS) can be challenging. A progressive course is highly common with brain tumors in MS and no single neuroimaging technique is foolproof when distinguishing between the two. We report a case of a 41-year-old female with relapsing–remitting multiple sclerosis, who had a suspicious lesion within the left frontal hemisphere, without a progressive course. The patient experienced paresthesias primarily to her right hand but remained stable without any functional decline and new neurological symptoms over the four years she was followed. The lesion was followed with brain magnetic resonance imaging (MRI) scans, positron emission tomography–computed tomography scans, and magnetic resonance spectroscopy. Together, these scans favored the diagnosis of a TDL, but a low-grade tumor was difficult to rule out. Examination of serial brain MRI scans showed an enlarging lesion in the left middle frontal gyrus involving the deep white matter. Neurosurgery was consulted and an elective left frontal awake craniotomy was performed. Histopathology revealed a grade II astrocytoma. This case emphasizes the importance of thorough and continuous evaluation of atypical MRI lesions in MS and contributes important features to the literature for timely diagnosis and treatment of similar cases.

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