Advertisement
Commentary| Volume 22, P57-58, May 2018

Download started.

Ok

Letter to the editor to the paper: “Acute and long-term effects of fingolimod on heart rhythm and heart rate variability in patients with multiple sclerosis”

      • Akbulak R.Ö.
      • Rosenkranz S.C.
      • Schaeffer B.N.
      • Pinnschmidt H.O.
      • Willems S.
      • Heesen C.
      • Hoffmann B.A.
      Acute and long-term effects of fingolimod on heart rhythm and heart rate variability in patients with multiple sclerosis.
      recently reported results of Holter ECG monitoring (HEM) following the first dose of fingolimod in a cohort of 64 MS patients. In this small cohort, the authors reported five (7.8%) patients with new-onset transient AV-block (AVB) (ranging from first-degree to second-degree type II (Mobitz)). In 4/5 patients (80%), the AVB could only be detected in the 72 h HEM with a median time of occurrence at 14 h. Although only one patient was symptomatic (dizziness), fingolimod treatment was discontinued in all of these mostly asymptomatic patients.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Multiple Sclerosis and Related Disorders
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Akbulak R.Ö.
        • Rosenkranz S.C.
        • Schaeffer B.N.
        • Pinnschmidt H.O.
        • Willems S.
        • Heesen C.
        • Hoffmann B.A.
        Acute and long-term effects of fingolimod on heart rhythm and heart rate variability in patients with multiple sclerosis.
        Mult. Scler. Relat. Disord. 2017; 19: 44-49https://doi.org/10.1016/j.msard.2017.10.020
        • Camm J.
        • Hla T.
        • Bakshi R.
        • Brinkmann V.
        Cardiac and vascular effects of fingolimod: mechanistic basis and clinical implications.
        Am. Heart J. 2014; 168: 632-644https://doi.org/10.1016/j.ahj.2014.06.028
        • DePaula R.S.
        • Antelmi I.
        • Vincenzi M.A.
        • André C.D.S.
        • Artes R.
        • Grupi C.J.
        • Mansur A.J.
        Cardiac arrhythmias and atrioventricular block in a cohort of asymptomatic individuals without heart disease.
        Cardiology. 2007; 108: 111-116https://doi.org/10.1159/000095950
        • DiMarco J.P.
        • O'Connor P.
        • Cohen J.A.
        • Reder A.T.
        • Zhang-Auberson L.
        • Tang D.
        • Collins W.
        • Kappos L.
        First-dose effects of fingolimod: pooled safety data from three phase 3 studies.
        Mult. Scler. Relat. Disord. 2014; 3: 629-638https://doi.org/10.1016/j.msard.2014.05.005
        • Gold R.
        • Comi G.
        • Palace J.
        • Siever A.
        • Gottschalk R.
        • Bijarnia M.
        • Rosenstiel
        • von P.
        • Tomic D.
        • Kappos L.
        • FIRST Study Investigators
        Assessment of cardiac safety during fingolimod treatment initiation in a real-world relapsing multiple sclerosis population: a phase 3b, open-label study.
        J. Neurol. 2014; 261: 267-276https://doi.org/10.1007/s00415-013-7115-8
        • Hilz M.J.
        • Intravooth T.
        • Moeller S.
        • Wang R.
        • Lee D.-H.
        • Koehn J.
        • Linker R.A.
        Central autonomic dysfunction delays recovery of fingolimod induced heart rate slowing.
        PLoS One. 2015; 10: e0132139https://doi.org/10.1371/journal.pone.0132139
        • Hilz M.J.
        • Wang R.
        • de Rojas Leal C.
        • Liu M.
        • Canavese F.
        • Roy S.
        • Hösl K.M.
        • Winder K.
        • Lee D.-H.
        • Linker R.A.
        Fingolimod initiation in multiple sclerosis patients is associated with potential beneficial cardiovascular autonomic effects.
        Ther. Adv. Neurol. Disord. 2017; 10: 191-209https://doi.org/10.1177/1756285616682936
        • Li K.
        • Konofalska U.
        • Akgün K.
        • Reimann M.
        • Rüdiger H.
        • Haase R.
        • Ziemssen T.
        Modulation of cardiac autonomic function by fingolimod initiation and predictors for fingolimod induced bradycardia in patients with multiple sclerosis.
        Front. Neurosci. 2017; 11: 540https://doi.org/10.3389/fnins.2017.00540
        • Limmroth V.
        • Ziemssen T.
        • Lang M.
        • Richter S.
        • Wagner B.
        • Haas J.
        • Schmidt S.
        • Gerbershagen K.
        • Lassek C.
        • Klotz L.
        • Hoffmann O.
        • Albert C.
        • Schuh K.
        • Baier-Ebert M.
        • Wendt G.
        • Schieb H.
        • Hoyer S.
        • Dechend R.
        • Haverkamp W.
        Electrocardiographic assessments and cardiac events after fingolimod first dose – a comprehensive monitoring study.
        BMC Neurol. 2017; 17: 11https://doi.org/10.1186/s12883-016-0789-7
        • Linker R.A.
        • Wendt G.
        Cardiac safety profile of first dose of fingolimod for relapsing-remitting multiple sclerosis in real- world settings: data from a German prospective multi-center observational study.
        Neurol. Ther. 2016; : 1-9https://doi.org/10.1007/s40120-016-0051-7
        • Schmouder R.
        FTY720: placebo-controlled study of the effect on cardiac rate and rhythm in healthy subjects.
        J. Clin. Pharmacol. 2006; 46: 895-904https://doi.org/10.1177/0091270006289853
        • Thomas K.
        • Proschmann U.
        • Ziemssen T.
        Fingolimod hydrochloride for the treatment of relapsing remitting multiple sclerosis.
        Expert Opin. Pharmacother. 2017; 18: 1649-1660https://doi.org/10.1080/14656566.2017.1373093
        • Ziemssen T.
        • Medin J.
        • Couto C.A.-M.
        • Mitchell C.R.
        Multiple sclerosis in the real world: a systematic review of fingolimod as a case study.
        Autoimmun. Rev. 2017; 16: 1-22https://doi.org/10.1016/j.autrev.2017.02.007
        • Ziemssen T.
        • Reimann M.
        • Gasch J.
        • Rüdiger H.
        Trigonometric regressive spectral analysis: an innovative tool for evaluating the autonomic nervous system.
        J. Neural Transm. 2013; 120: S27-S33https://doi.org/10.1007/s00702-013-1054-5