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A case study published in Reactions Weekly reported on a patient with secondary progressive multiple sclerosis (SPMS) who showed lack of efficacy while being treated with siponimod. The patient had a history of MS and was initially on fingolimod before transitioning to siponimod. Despite the switch, the patient exhibited radiological activity and a new hyperintense T2 lesion without contrast enhancement, leading to the conclusion of lack of efficacy with siponimod. [Extracted from the article]

This article discusses eight case reports of patients with relapsing-remitting multiple sclerosis (RRMS) who experienced adverse effects while being treated with fingolimod or ozanimod. The patients, ranging in age from 33 to 60 years, developed lymphopenia, liver enzyme elevation, or drug-induced liver injury. In some cases, the medications were discontinued and replaced with alternative treatments, resulting in improved outcomes. These case reports highlight potential risks associated with these medications in the treatment of RRMS. [Extracted from the article]

A case report published in Reactions Weekly describes a woman in her 30s who experienced a rebound effect in the form of a multiple sclerosis (MS) relapse after discontinuing fingolimod while being treated for MS. The woman had been diagnosed with MS and optic neuritis in 2005 and had been receiving various treatments over the years. After discontinuing fingolimod due to a planned second pregnancy, she experienced a severe MS relapse and her condition worsened despite treatment with methylprednisolone and alemtuzumab. However, after receiving immune-globulin therapy, her MS symptoms significantly improved. [Extracted from the article]

A 67-year-old woman developed a lymphoproliferative disorder while being treated with fingolimod for relapsing-remitting multiple sclerosis (RRMS). She had been diagnosed with RRMS in 1989 and had tried various treatments before switching to fingolimod in 2012. After experiencing cutaneous CD30+ T-cell lymphoproliferative disorder in 2022, she discontinued fingolimod and was switched to diroximel fumarate, which led to clinical improvement without the need for additional immunotherapy. [Extracted from the article]

A 37-year-old woman developed Balo's concentric sclerosis while being treated with fingolimod for relapsing-remitting multiple sclerosis. She presented with acute right-sided hemiparesis, which was later attributed to fingolimod-induced Balo's concentric sclerosis after ruling out infectious causes. Treatment with methylprednisolone and rituximab post fingolimod cessation resulted in improved symptoms for the patient. [Extracted from the article]

A 32-year-old woman developed generalised and patch granuloma annulare while being treated with fingolimod for multiple sclerosis. She had a history of psoriasis and asthma, and her skin lesions appeared two months after starting fingolimod. The woman discontinued the medication due to the skin lesions, but also reported a new psoriasis plaque on her arm. Dermatological examination revealed erythematous macules and plaques on various parts of her body, and a histopathological examination confirmed the diagnosis of granuloma annulare. The woman was treated with tacrolimus and hydrocortisone-butyrate, but the outcome of the adverse drug reaction was not stated. [Extracted from the article]

A 56-year-old woman developed a Cryptococcus neoformans infection and lymphopenia while being treated with fingolimod for multiple sclerosis. She had a history of MS and had been receiving fingolimod treatment for 45 months when she developed a non-healing rash and a crusty lesion. A skin biopsy confirmed cryptococcal infection, and both serum and CSF tests were positive for Cryptococcus neoformans. The woman discontinued fingolimod treatment and her lymphopenia gradually improved after receiving treatment with amphotericin-B and fluconazole. Eight months later, she started a new treatment with peginterferon beta-1a. [Extracted from the article]

A case report published in Reactions Weekly describes a woman in her 30s who experienced rebound effect in the form of tumefactive multiple sclerosis after discontinuing fingolimod treatment for relapsing-remitting multiple sclerosis (RRMS). She subsequently developed paradoxical multiple sclerosis after receiving alemtuzumab treatment for RRMS. The woman initially had disease stability while on fingolimod but discontinued it due to a desire for pregnancy. After discontinuation, she experienced severe disease activation and was treated with methylprednisolone and plasma exchange. MRI scans showed multiple lesions, including tumefactive demyelinating lesions. Treatment with natalizumab resulted in a reduction in the size and enhancement of the lesions. [Extracted from the article]

A 55-year-old woman with progressive relapsing multiple sclerosis (RR-MS) developed inflammatory immune reconstitution syndrome (IIRIS) after stopping treatment with cladribine. She had previously been treated with interferon-beta and fingolimod, but experienced a severe flare-up in February 2022. After completing a cycle of cladribine, she experienced a sensation of imbalance and her brain MRI showed new active inflammatory lesions. IIRIS was confirmed and she received corticosteroids and a second cycle of cladribine, leading to improvement. [Extracted from the article]

A retrospective cohort study reported a case of a foetus developing a major congenital malformation after in-utero exposure to fingolimod, a medication used for multiple sclerosis. The mother, who had multiple sclerosis, took fingolimod during her pregnancy. The specific outcome of the foetus is not mentioned in the article. This information highlights a potential risk associated with the use of fingolimod during pregnancy. [Extracted from the article]

A 55-year-old woman with relapsing remitting multiple sclerosis (MS) exhibited lack of efficacy during treatment with dimethyl-fumarate. She had initially been treated with interferon β but switched to dimethyl fumarate in 2019. However, her MS worsened despite receiving dimethyl-fumarate, leading to her hospitalization. In February 2021, she started mitoxantrone due to the transition of her MS to a secondary progressive form, but this treatment was stopped after the fourth dose in August 2021. [Extracted from the article]

A 33-year-old woman developed soft palate malignant melanoma while being treated with fingolimod for relapse-remitting multiple sclerosis (RRMS). She had a history of RRMS and initially received interferon β-1a before switching to fingolimod. The woman presented with nasal congestion and rhinorrhagia, and examination revealed a swollen right soft palate and brown irregular maculae in the nasal cavity. Further imaging confirmed a large mass in the nasal cavity, and a biopsy confirmed the malignancy. Fingolimod was discontinued, and the woman underwent surgery and additional tests to assess for metastasis. She was then referred to an oncology clinic for further treatment. [Extracted from the article]

A 33-year-old woman with relapsing remitting multiple sclerosis developed a cryptococcal fungal infection while being treated with fingolimod. She presented with a skin lesion on her abdomen and a biopsy confirmed the infection. The woman had a low absolute lymphocyte count, which may have contributed to the development of the infection. The article does not provide information on the duration of treatment or the outcome of the infection. [Extracted from the article]

Two girls, aged 14 and 13, developed first-degree atrioventricular block or second-degree atrioventricular block while being treated with fingolimod for multiple sclerosis. The 14-year-old girl experienced asymptomatic bradycardia and first-degree atrioventricular block, which resolved after 12 hours. The 13-year-old girl developed second-degree atrioventricular block, which then regressed to first-degree atrioventricular block before returning to normal. It was determined that the atrioventricular block in both girls was related to the use of fingolimod. [Extracted from the article]

Author InformationAn event is serious (based on the ICH definition) when the patient outcome is:• * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important eventA 41-year-old woman developed molluscum contagiosum infection during treatment with fingolimod for relapsing-remitting multiple sclerosis [route, dosage and duration of treatment to reaction onset not stated]. [Extracted from the article]

In a monocentric longitudinal observational study, four patients with relapsing-remitting multiple sclerosis (RRMS) were described who did not respond to treatment with cladribine. The patients received cladribine at a dose of 3.5 mg/kg for two weeks, once per year. One patient also received fingolimod and cyclophosphamide. Despite treatment with cladribine, all four patients showed no therapeutic response. Their treatment was subsequently switched to ocrelizumab or alemtuzumab. [Extracted from the article]

A 72-year-old man developed generalized pustular psoriasis while being treated with fingolimod for multiple sclerosis. He also experienced a flare of the psoriasis after reducing the dose of etretinate. The man had been receiving fingolimod for over 4 years and had been using betamethasone-butyrate-propionate for recurrent eruptions. He was diagnosed with generalized pustular psoriasis secondary to fingolimod treatment and was successfully treated with etretinate and maxacalcitol. No exacerbation of multiple sclerosis was observed during this time. [Extracted from the article]

In a retrospective observational cohort study, a patient with multiple sclerosis developed lymphopenia while receiving treatment with fingolimod. The study involved 78 patients with multiple sclerosis and took place between March 2008 and March 2019. The severity of the lymphopenia and the outcome of the patient were not specified in the article. [Extracted from the article]

A 46-year-old man developed monkeypox virus infection and lymphopenia while being treated with fingolimod for relapsing-remitting multiple sclerosis (MS). The man had controlled MS and had been taking fingolimod for a long time. He developed painful skin lesions and tests revealed monkeypox virus infection. He also experienced various other symptoms, including gastrointestinal bleeding, lymphadenopathy, and urinary retention. Fingolimod was discontinued and the man's condition improved with supportive treatment. [Extracted from the article]

Owing to high suspicion for PML-IRIS, the CSF sample was again tested at another laboratory that showed qualitatively positive result upon JCV PCR. Fifteen months after the initial presentation, she experienced worsening in gait ataxia and another MRI of the brain showed new enhancing lesion of the right periventricular white matter. But, owing to high radiographic and clinical suspicion of PML, the CSF sample was tested at another laboratory and qualitatively positive result was noted upon another CSF JCV PCR. [Extracted from the article]

B Author Information b An event is serious (based on the ICH definition) when the patient outcome is: * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important event A 48-year-old man developed osteonecrosis of the femoral head or periprosthetic joint infection (PJI) due to I Mycoplasma hominis i during immunosuppressant treatment with fingolimod or prednisolone for multiple sclerosis [MS; I not all routes and dosages stated i ]. Therefore, 11 days before admission, total hip arthroplasty of the right hip was performed for steroid (prednisolone)-induced osteonecrosis of the femoral head. The man, who had MS, was hospitalised due to fever and worsening pain in the right hip. [Extracted from the article]

B Author Information b An event is serious (based on the ICH definition) when the patient outcome is: * death * life-threatening * hospitalisation * disability * congenital anomaly * other medically important event A 46-year-old woman developed chest wall mass secondary to I Cryptococcus neoformans i ( I C. neoformans i ), rib osteomyelitis and generalised itching during treatment with fingolimod or fluconazole for relapsed/remitting multiple sclerosis (MS) or cryptococcal chest wall mass [ I not all routes, dosages and outcomes stated; duration of treatments to reaction onsets not stated i ]. On 24 February 2022, a chest CT revealed left chest wall mass along with an erosion of left 7 SP th sp rib subtle pathologic fracture. [Extracted from the article]