Correspondence| Volume 66, 104066, October 2022

Download started.


Disease reactivation after fingolimod cessation in Multiple Sclerosis patients with pregnancy desire: A retrospective study


      Reactivation of Multiple Sclerosis (MS) activity has been described after fingolimod cessation. Because of its contra indication during pregnancy, switch towards lower efficacy treatments are frequent in MS patients with childbearing desire but expose them to a risk of disease reactivation.
      In this retrospective study including 44 women with MS, a significant increase of the median annualized relapse rate was found in the year following fingolimod discontinuation compared to the period before (p < 0.0001), and 57% of women experienced at least one relapse.
      When considering to start fingolimod, particular attention should be paid to women with a short-term pregnancy desire.


      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 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


        • Frau J.
        • Sormani M.P.
        • Signori A.
        • et al.
        Clinical activity after fingolimod cessation: disease reactivation or rebound?.
        Eur. J. Neurol. 2018; 25: 1270-1275
        • Sato K.
        • Niino M.
        • Kawashima A.
        • Yamada M.
        • Miyazaki Y.
        • Fukazawa T.
        Disease exacerbation after the cessation of fingolimod treatment in japanese patients with Multiple Sclerosis.
        Intern. Med. 2018; 57: 2647-2655
        • Bianco A.
        • Lucchini M.
        • Totaro R.
        • Fantozzi R
        • De Luca G
        • Di Lemme S
        • Presicce G
        • Evangelista L
        • Di Tommaso V
        • Pastorino R
        • De Fino C
        • De Arcangelis V
        • Centonze D
        • Mirabella M
        Disease reactivation after fingolimod discontinuation in pregnant Multiple Sclerosis patients.
        Neurotherapeutics. 2021; 18 (Epub 2021 Sep 7): 2598-2607
        • Goncuoglu C.
        • Tuncer A.
        • Bayraktar-Ekincioglu A.
        • et al.
        Factors associated with fingolimod rebound: a single center real-life experience.
        Mult. Scler. Relat. Dis. 2021; 56103278
        • Uygunoglu U.
        • Tutuncu M.
        • Altintas A.
        • Saip S.
        • Siva A.
        Factors predictive of severe Multiple Sclerosis disease reactivation after fingolimod cessation.
        Neurologist. 2018; 23: 12-16
        • Sepúlveda M.
        • Montejo C.
        • Llufriu S.
        • et al.
        Rebound of Multiple Sclerosis activity after fingolimod withdrawal due to planning pregnancy: analysis of predisposing factors.
        Mult. Scler. Relat. Dis. 2020; 38101483
        • Hatcher S.E.
        • Waubant E.
        • Nourbakhsh B.
        • Crabtree-Hartman E.
        • Graves JS.
        Rebound syndrome in patients with Multiple Sclerosis after cessation of fingolimod treatment.
        JAMA Neurol. 2016; 73: 790
        • Vermersch P.
        • Radue E.W.
        • Putzki N.
        • Ritter S.
        • Merschhemke M.
        • Freedman MS.
        A comparison of Multiple Sclerosis disease activity after discontinuation of fingolimod and placebo.
        Mult. Scler. J. Exp. Transl. Clin. 2017; 32055217317730096
        • Yeh W.Z.
        • Widyastuti P.A.
        • Walt A.V.
        • et al.
        Natalizumab, fingolimod, and dimethyl fumarate use and pregnancy-related relapse and disability in women with Multiple Sclerosis.
        Neurology. 2021; 96: e2989-e3002
        • Alroughani R.
        • Alowayesh M.S.
        • Ahmed S.F.
        • Behbehani R.
        • Al-Hashel J.
        Relapse occurrence in women with Multiple Sclerosis during pregnancy in the new treatment era.
        Neurology. 2018; 90: e840-e846