Highlights
- •3 (42%) patients suffered rebound after fingolimod cessation for pregnancy planning.
- •Pregnancy failed to halt such exaggerated inflammatory activity.
- •New-borns were delivered healthy despite using steroids throughout pregnancy.
- •Lymphocyte count <300/ul was related to reappearance of activity disease.
Abstract
Background
Rebound of multiple sclerosis (MS) activity has been described after the withdrawal
of high-efficacy drugs, but its impact during pregnancy is less known. We describe
a series of cases of rebound syndrome after the cessation of fingolimod due to pregnancy
planning.
Methods
The clinical and radiological data of 7 MS patients who discontinued fingolimod therapy
between May 2012 and March 2018 to plan a pregnancy was analysed.
Results
Three (42.8%) of the 7 patients experienced a rebound effect, all of whom became pregnant.
During pregnancy, the 3 patients had a mean (SD) of 5.3 (1.3) relapses, and 13 of
the 15 relapses were treated with intravenous steroids and/or immunoglobulin. These
patients experienced a median increase of 3 points in the Expanded Disability Status
Scale (range, 2–4), as well as a median increase of 27 new gadolinium-enhancing lesions
(range, 9–40) and 38 new T2 lesions in a post-partum MRI (range, 21–70). The 3 pregnancies
resulted in the delivery of healthy babies. A strong correlation was found between
the lymphocyte count at fingolimod onset and the annual relapse rate in the period
without therapy (r= -0.84, p = 0.005). The time to first relapse was shorter in patients who had <300/μl lymphocytes
at fingolimod onset (median time 46 vs 426 days, p = 0.010).
Conclusion
Rebound activity after fingolimod suspension represents a severe long-lasting inflammatory
syndrome that may affect up to 40% of female MS patient who discontinue therapy due
to pregnancy planning. Lymphopenia (<300/μl) in the first 3 months of fingolimod onset
may predispose patients to suffer earlier and higher disease activity upon cessation.
Keywords
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Article info
Publication history
Published online: October 29, 2019
Accepted:
October 27,
2019
Received in revised form:
October 3,
2019
Received:
July 15,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
