Fingolimod for Multiple Sclerosis; Mechanism of Action, Safety and Toxicity

Context: From the year 2010, for patients with highly active relapsing-remitting (RR) multiple sclerosis (MS), fingolimod could be justified for prescription as an oral medication. Previous published clinical trials identified that the drug could reduce auto-aggressive lymphocyte infiltration into the central nervous system (CNS) through the blood brain barrier (BBB), by stoppage of lymphocyte passage from lymphoid tissues. Evidence Acquisition: The aim of this study was to provide a comprehensive review related to the pharmacotherapy of fingolimod for MS, by gathering data related to previous clinicalandlaboratory trials. The key words relevant to the topic were searched through the United States national library of medicine. Significant manuscripts associated with fingolimod pharmacotherapy for MS were nominated and studied completely. Results: In patients with MS due to multifactorial pathogenesis, in both white and gray matter of CNS, multifocal lesions might be recognized. CD4(+) and CD8(+) effector T cells, sensitive to CNS myelin antigens, are assumed to facilitate the preliminary stage of injury formation. Fingolimod -therapy in patients at the RRMS phase, reserve lymphocyte egress from lymphocyte nodes and disturb its' recirculation in the CNS. Previous clinical trials confirmed that once-daily oral administration of 0.5 mg fingolimod for one year causes a decrease in annualized relapse rate. Reduction in the annualized relapse rate has been reported, related to the study of 249 patients with RRMS. Reduction in disability progression after three and six months has been reported, respectively. The numbers of new or newly enlarged T2 lesions were shown to have reduced. Head cold, headache, fatigue, macular edema, herpes and zoster infections, bradycardia, relapse and basal-cell carcinoma have been reported as side-effects related to finglimod-therapy for MS. Conclusions: However, fingolimod-therapy could provide flexibility regarding the ease of oral use for patients with RRMS, but rationalization related to the prescription are largely based on inter-and intra-individual variation. Due to unpredictability in disease manifestation and its' progression, caution must be taken with drug prescription. Additional studies based on advanced pharmacotherapy trials appear to be valuable.