Questions of management of patients with hard-to-treat remitting multiple sclerosis

Медицинский совет

V. V. Murugin¹  M. V. Melnikov¹  A. N. Boiko²  M. V. Paschenkov³  E. V. Popova³ 

[1] Russian National Research Medical University named after N.I. Pirogov;Neurosurgery and Medical Genetics;Сity Clinical Hospital №24;

关键词: рассеянный склероз;    инвалидизация обострения;    финголимод;    интерлейкин-17;    препараты, изменяющие течение рассеянного склероза;    multiple sclerosis;    fingolimod;    interleukin-17;    multiple sclerosis disease modifying drugs;    disability;    exacerbation;   

DOI  :  10.21518/2079-701X-2015-10-63-65

来源: DOAJ

【 摘 要 】

82 patients diagnosed with remitting multiple sclerosis, (MS) undergoing treatment with fingolimod were followed up for minimum 12 months at the Moscow Multiple Sclerosis Centre. The purpose of the follow-up was to evaluate the effects of fingolimod. 9 of 12 patients were subject to a comprehensive immunological examination to identify subpopulations of circulating T-cells. All patients were in clinical remission at the time of recruitment. All patients showed a significant decrease in the frequency of exacerbations during therapy with fingolimod. The disability status on the EDSS scale did not progress during the whole year of the follow-up. The therapy showed significant decrease in the production of IL-17 and the amount of TH17 cells in comparison with the control group, thus demonstrating a relevant decrease in the the autoimmune process activity. Withdrawal of fingolimod in 6-8 weeks was associated with normalization of the lymphocyte level in the peripheral blood due to drug elimination and wash-out of S1P receptors. However, given that wash-out of S1P receptors results in increased production of IL-17 and, consequently, higher BBB permeability, it is appropriate to name the disease reactivation as "rebound syndrome" which is primarily associated with a sharp increase in IL-17. This raises questions about management of patients who for various reasons need withdrawal of fingolimod therapy.

【 授权许可】

Unknown