scholarly journals Case Report: Fingolimod and Cryptococcosis

2019 ◽  
Vol 21 (6) ◽  
pp. 275-280 ◽  
Author(s):  
Rohini D. Samudralwar ◽  
Andrej Spec ◽  
Anne H. Cross
Keyword(s):  
Multiple Sclerosis ◽  
Case Report ◽  
Cryptococcal Meningitis ◽  
Demyelinating Disease ◽  
Opportunistic Infections ◽  
Safety Data ◽  
Pulmonary Cryptococcosis ◽  
Disease Modifying Therapies ◽  
Disease Modifying ◽  
Ongoing Infection

Abstract The use of immunomodulatory and immunosuppressive therapies in multiple sclerosis (MS) has allowed practitioners to regulate MS disease activity, with the caveat that these potent medications may render patients susceptible to opportunistic infections. The approval of fingolimod presented the first oral option for relapsing MS. Since 2015, postmarketing safety data have documented several published cases of cryptococcal meningitis and disseminated cryptococcosis associated with fingolimod use. However, surveillance mechanisms for opportunistic infections and management of active demyelinating disease with ongoing infection have not been adequately addressed. We present a case of isolated pulmonary cryptococcosis with the use of fingolimod to highlight the hurdles in balancing efficacious disease-modifying therapies for MS while treating an opportunistic infection associated with that therapy.

Cutaneous cryptococcosis in a patient taking fingolimod for multiple sclerosis: Here come the opportunistic infections?

2017 ◽  
Vol 23 (2) ◽  
pp. 297-299 ◽  
Author(s):  
Adam F Carpenter ◽  
Shikha J Goodwin ◽  
Peter F Bornstein ◽  
Andrew J Larson ◽  
Christine K Markus
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Trials ◽  
Case Report ◽  
Skin Lesion ◽  
Opportunistic Infections ◽  
Oral Disease ◽  
Disease Modifying Therapy ◽  
Post Marketing ◽  
Disease Modifying ◽  
Cutaneous Cryptococcosis

Background: Fingolimod is an oral disease-modifying therapy for relapsing forms of multiple sclerosis, which acts by sequestering lymphocytes within lymph nodes. Objective: To describe a case of extrapulmonary cryptococcosis in a patient taking fingolimod. Methods: Case report. Results: A 47-year-old man developed a non-healing skin lesion approximately 16 months after starting treatment with fingolimod. Biopsy revealed cryptococcosis. Fingolimod was discontinued and the lesion resolved with antifungal therapy. Conclusion: Despite few reported opportunistic infections in the pivotal clinical trials and first few years post-marketing, there has been a recent increase in reported AIDS-defining illnesses in patients taking fingolimod. Neurologists should be alert for opportunistic infections in their patients using this medication.

scholarly journals New and Emerging Disease-Modifying Therapies for Relapsing-Remitting Multiple Sclerosis: What is New and What is to Come

2012 ◽  
Vol 4 ◽  
pp. JCNSD.S6692 ◽  
Author(s):  
J. Nicholas ◽  
B. Morgan-Followell ◽  
D. Pitt ◽  
M.K. Racke ◽  
A. Boster
Keyword(s):  
Multiple Sclerosis ◽  
Safety Data ◽  
Treatment Algorithms ◽  
Disease Modifying Therapies ◽  
Therapeutic Landscape ◽  
Oral Agents ◽  
Relapsing Remitting ◽  
Disease Modifying ◽  
To Come ◽  
Relapsing Remitting Multiple Sclerosis

The therapeutic landscape for multiple sclerosis (MS) is rapidly changing. Currently, there are eight FDA approved disease modifying therapies for MS including: IFN-β-1a (Avonex, Rebif), IFN-β-1b (Betaseron, Extavia), glatiramer acetate (Copaxone), mitoxantrone (Novantrone), natalizumab (Tysabri), and fingolimod (Gilenya). This review will highlight the experience to date and key clinical trials of the newest FDA approved agents, natalizumab and fingolimod. It will also review available efficacy and safety data on several promising therapies under active investigation including four monoclonal antibody therapies: alemtuzumab, daclizumab, ocrelizumab and ofatumumab and three oral agents: BG12, laquinimod, and teriflunomide. To conclude, we will discuss where each of these new therapies may best fit into treatment algorithms.

Update on disease-modifying therapies for multiple sclerosis

2017 ◽  
Vol 65 (5) ◽  
pp. 883-891 ◽  
Author(s):  
Diana L Vargas ◽  
William R Tyor
Keyword(s):  
Multiple Sclerosis ◽  
Inflammatory Response ◽  
Demyelinating Disease ◽  
Jc Virus ◽  
Healthcare Providers ◽  
White Matter Lesions ◽  
Adequate Treatment ◽  
Disease Modifying Therapies ◽  
Oral Agents ◽  
Disease Modifying

Multiple sclerosis (MS) is an autoimmune, demyelinating disease of the central nervous system (CNS). It predominantly affects young women and is one of the most common causes of disability in young adults. MS is characterized by formation of white matter lesions in the CNS as a result of inflammation, demyelination, and axonal loss. Treatment has been a focus of neurological research for over 60 years. A number of disease-modifying therapies (DMTs) have become available making MS a treatable disease. These compounds target the inflammatory response in MS. They work by decreasing the chances of relapse, decreasing the chances of new lesion formation seen on MRI of the CNS and slowing the accumulation of disability. The first drugs for MS to be available were interferon-β and glatiramer acetate. These work by modulating the inflammatory response via different mechanisms that are briefly discussed. Newer agents have since become available and have significantly changed the dynamics of MS treatment. These include fingolimod, dimethyl fumarate and teriflunomide, which are oral agents. Other second-line and third-line Food and Drug Administration (FDA) approved medications include natalizumab and alemtuzumab. Natalizumab is considered one of the most potent treatments for relapse prevention. However, the high risk of progressive multifocal leukoencephalopathy (PML), which is caused by JC virus infection in the brain, tempers the more widespread use of this agent; nevertheless, JC virus antibody tests have helped to stratify the risk of PML. Alemtuzumab, which also has a considerable side effect profile, is likewise highly efficacious. Ocrelizumab, a monoclonal antibody to CD20 on B cells, is a highly effective agent for MS that is likely to be approved soon by the FDA. MS is a major contributor to healthcare costs and it is critical that healthcare providers be aware of the availability and benefits of DMTs. It is imperative that prompt and adequate treatment be established on diagnosis. Changes in therapy should be considered when there is evidence of disease activity as well as accumulation of disability or safety or tolerability concerns.

scholarly journals Ethical use of off-label disease-modifying therapies for multiple sclerosis

2021 ◽  
pp. 135245852110302
Author(s):  
Joanna Laurson-Doube ◽  
Nick Rijke ◽  
Anne Helme ◽  
Peer Baneke ◽  
Brenda Banwell ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
World Health ◽  
World Federation ◽  
Off Label ◽  
Disease Modifying Therapies ◽  
The World ◽  
Disease Modifying ◽  
Health Organization

Background: Off-label disease-modifying therapies (DMTs) for multiple sclerosis (MS) are used in at least 89 countries. There is a need for structured and transparent evidence-based guidelines to support clinical decision-making, pharmaceutical policies and reimbursement decisions for off-label DMTs. Objectives/Results: The authors put forward general principles for the ethical use of off-label DMTs for treating MS and a process to assess existing evidence and develop recommendations for their use. Conclusion: The principles and process are endorsed by the World Federation of Neurology (WFN), American Academy of Neurology (AAN), European Academy of Neurology (EAN), Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS), European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), Middle-East North Africa Committee for Treatment and Research in Multiple Sclerosis (MENACTRIMS) and Pan-Asian Committee for Treatment and Research in Multiple Sclerosis (PACTRIMS), and we have regularly consulted with the Brain Health Unit, Mental Health and Substance Use Department at the World Health Organization (WHO).

scholarly journals Disease‐Modifying Therapies and Coronavirus Disease 2019 Severity in Multiple Sclerosis

2021 ◽  
Author(s):  
Maria P. Sormani ◽  
Nicola De Rossi ◽  
Irene Schiavetti ◽  
Luca Carmisciano ◽  
Cinzia Cordioli ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Disease Modifying Therapies ◽  
Disease Modifying
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