- •Rebound occurs in about 10% of MS patients who discontinued fingolimod.
- •Rebound was more common in younger patients.
- •Long washout period after discontinuation of fingolimod may increase the likelihood of rebound.
Background It is still controversial whether the relapse experienced after discontinuation of fingolimod treatment is a rebound. Increasing cases of rebound have been reported in the literature. The rate of fingolimod rebound in patients after fingolimod cessation is reported between 5% and 52%. The present study aims to determine the rate of rebound after discontinuation of fingolimod treatment and the factors affecting the rebound.
Methods This retrospective cohort study consists of adult MS patients who have been admitted to the Hacettepe University Hospital Neurology MS Center outpatient clinic between 2012 and 2020.
Results During the study period, 642 patients received fingolimod and 23.1% discontinued the fingolimod treatment. Thirteen of 126 patients had a rebound (10.3%) after fingolimod discontinuation. The patients in the rebound group were significantly younger and washout period were significantly longer than those in the non-rebound group. After discontinuation of fingolimod treatment, the EDSS score of the rebound group was significantly higher than the non-rebound group, while Annualized Relapse Rates were similar.
Conclusion Younger age, longer washout time, and previous treatment preferences may increase the occurrence probability of rebound. It is recommended that patients should be closely monitored after fingolimod discontinuation and appropriate disease-modifying therapy should be initiated as soon as possible.
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
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Fingolimod for the treatment of relapsing-remitting multiple sclerosis.Turk. J. Neurol. 2017; 23: 176-185
- Rebound exacerbation multiple sclerosis following cessation of oral treatment.Mult. Scler. Relat. Disord. 2013; 2: 252-255
- Severe disease reactivation in four patients with relapsing-remitting multiple sclerosis after fingolimod cessation.J. Neuroimmunol. 2015; 282: 118-122
- Dysregulation of sphingosine 1 phosphate receptor-1 (S1P1) signaling and regulatory lymphocyte-dependent immunosuppression in a model of post-fingolimod MS rebound.Brain Behav. Immun. 2015; 50: 78-86
- Fingolimod may support neuroprotection via blockade of astrocyte nitric oxide.Ann. Neurol. 2014; 76: 325-337
- Severe disease exacerbations in patients with multiple sclerosis after discontinuing fingolimod.Neurol. Neurochir. Pol. 2017; 51: 156-162
- Dramatic recovery of steroid-refractory relapsed multiple sclerosis following Fingolimod discontinuation using selective immune adsorption.BMC Neurol. 2015; 15: 125
- Frequency and clinical characteristics of multiple sclerosis rebounds after withdrawal of Fingolimod.CNS Neurosci. Ther. 2018; 24: 984-986
- Tumefactive multiple sclerosis lesions in two patients after cessation of fingolimod treatment.Ther. Adv. Neurol. Disord. 2015; 8: 233-238
- Severe exacerbation of multiple sclerosis following withdrawal of Fingolimod.Clin. Drug Investig. 2019; 39: 909-913
- Clinical activity after fingolimod cessation: disease reactivation or rebound?.Eur. J. Neurol. 2018; 25: 1270-1275
- Catastrophic outcome of patients with a rebound after Natalizumab treatment discontinuation.Brain Behav. 2017; 7: e00671
- Severe rebound after withdrawal of fingolimod treatment in patients with multiple sclerosis.Mult. Scler. Relat. Disord. 2017; 11: 1-3
- Management of multiple sclerosis and the integration of related specialty pharmacy programs within health systems.Am. J. Health Syst. Pharm. 2016; 73: 811-819
- Rebound syndrome in patients with multiple sclerosis after cessation of Fingolimod treatment.JAMA Neurol. 2016; 73: 790-794
- Rebound of disease activity after withdrawal of fingolimod (FTY720) treatment.Arch. Neurol. 2012; 69: 262-264
- Comparative efficacy and discontinuation of dimethyl fumarate and fingolimod in clinical practice at 12-month follow-up.Mult. Scler. Relat. Disord. 2016; 10: 44-52
- Alemtuzumab as rescue therapy in a cohort of 50 relapsing-remitting MS patients with breakthrough disease on fingolimod: a multi-center observational study.J. Neurol. 2018; 265: 1521-1527
- ECTRIMS/EAN Guideline on the pharmacological treatment of people with multiple sclerosis.Mult. Scler. 2018; 24: 96-120
- Tumefactive multiple sclerosis lesions associated with fingolimod treatment: Report of 5 cases.Mult. Scler. Relat. Disord. 2018; 25: 95-98
- Disease exacerbation after the cessation of Fingolimod treatment in Japanese patients with multiple sclerosis.Intern. Med. 2018; 57: 2647-2655
- Rebound of multiple sclerosis activity after fingolimod withdrawal due to planning pregnancy: Analysis of predisposing factors.Mult. Scler. Relat. Disord. 2020; 38101483
- Recurrence or rebound of clinical relapses after discontinuation of natalizumab therapy in highly active MS patients.J. Neurol. 2014; 261: 1170-1177
- Treatment of multiple sclerosis - success from bench to bedside.Nat. Rev. Neurol. 2019; 15: 53-58
- Factors predictive of severe multiple sclerosis disease reactivation after Fingolimod cessation.Neurologist. 2018; 23: 12-16
- A comparison of multiple sclerosis disease activity after discontinuation of fingolimod and placebo.Mult. Scler. J. Exp. Transl. Clin. 2017; 32055217317730096
- An observational study of alemtuzumab following fingolimod for multiple sclerosis.Neurol. Neuroimmunol. Neuroinflamm. 2017; 4: e320
Published online: September 26, 2021
Accepted: September 23, 2021
Received in revised form: September 6, 2021
Received: June 28, 2021
© 2021 Elsevier B.V. All rights reserved.