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Semin Neurol 2013; 33(01): 037-044
DOI: 10.1055/s-0033-1343794
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Fingolimod Therapy for Multiple Sclerosis

Mary A. Willis
1   Neurological Institute, The Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, Ohio
,
Jeffrey A. Cohen
1   Neurological Institute, The Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, Ohio
› Author Affiliations
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Publication History

Publication Date:
25 May 2013 (online)

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Abstract

Because of its potent efficacy and oral route of administration, the approval of fingolimod as treatment for relapsing-remitting multiple sclerosis (MS) was highly anticipated. The therapeutic and adverse effects are mediated by modulation of sphingosine 1-phosphate receptors. Fingolimod inhibits the egress of lymphocytes from lymph nodes and may also have direct effects on the central nervous system. The clinical trials that led to the approval of fingolimod demonstrated benefit on relapses, disability progression, magnetic resonance imaging (MRI) activity, and brain volume loss in treatment-naïve and previously treated patients with relapsing-remitting MS. The use of fingolimod in clinical practice has been limited by concerns for cardiac effects, infection, and macular edema as well as the relative lack of long-term safety data for this drug with a novel mechanism of action. Additional clinical trial and postmarketing data suggest that fingolimod is a safe, effective, and well-tolerated treatment option when patients are selected and monitored appropriately.

Keywords

multiple sclerosis - therapy - fingolimod - sphingosine 1-phosphate
 

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