Rebound of disease activity after withdrawal of fingolimod (FTY720) treatment.

ABSTRACT

BACKGROUND: The oral sphingosine-1-phosphate receptor modulator fingolimod (FTY720) was recently approved for the treatment of relapsing-remitting multiple sclerosis. To date, data about a possible recurrence of disease activity after discontinuation of fingolimod treatment are scarce. OBJECTIVE: To describe a patient who discontinued fingolimod treatment after a local malignant melanoma was diagnosed. Three months after cessation, he had a striking rebound of multiple sclerosis activity. DESIGN: Case report and review of literature. SETTING: Institute of Clinical Neuroimmunology, Ludwig-Maximilians-University, Munich, Germany. PATIENT A 45-year-old man diagnosed as having relapsing-remitting multiple sclerosis. MAIN OUTCOME MEASURES: Multiple sclerosis disease activity including annual relapse rate, Expanded Disability Status Scale score, and number of gadolinium-enhancing lesions on magnetic resonance imaging before, during, and after treatment with fingolimod. RESULTS: Three months after discontinuation of treatment with fingolimod, the patient experienced a severe relapse, with Expanded Disability Status Scale score progression from 2.5 to 4.5. On brain and spinal magnetic resonance imaging, he showed a rebound of disease activity, with a drastic increase of gadolinium-enhancing lesions (>20). CONCLUSIONS: Two aspects relevant to any newly approved multiple sclerosis treatment with immunomodulatory properties are highlighted with this case first, possible rebound of disease activity after discontinuation; second, the occurrence of a tumor as a possible treatment-related complication.