ArticleBMC neurology2015
Dramatic recovery of steroid-refractory relapsed multiple sclerosis following Fingolimod discontinuation using selective immune adsorption.
Article in BMC neurology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it, 23 citations in OpenAlex.
- Disease-modifying therapies and hematological disorders: a systematic review of case reports and case series.Frontiers in neurology · 2024Pooled it
- Fingolimod Rebound: A Review of the Clinical Experience and Management Considerations.Neurology and therapy · 2019Review
- Severe Exacerbation of Multiple Sclerosis Following Withdrawal of Fingolimod.Clinical drug investigation · 2019Review
- Disease Exacerbation after the Cessation of Fingolimod Treatment in Japanese Patients with Multiple Sclerosis.Internal medicine (Tokyo, Japan) · 2018Article
- Neurological safety of fingolimod: An updated review.Clinical & experimental neuroimmunology · 2017Review
- Cladribine to treat disease exacerbation after fingolimod discontinuation in progressive multiple sclerosis.Annals of clinical and translational neurology · 2017Article
- Severe tumefactive rebound of multiple sclerosis following fingolimod cessation.BMJ case reports · 2016Article
- Immunoadsorption therapy in autoimmune encephalitides.Neurology(R) neuroimmunology & neuroinflammation · 2016Article
- Fingolimod for multiple sclerosis and emerging indications: appropriate patient selection, safety precautions, and special considerations.Therapeutics and clinical risk management · 2016Review
Corrections and comments
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Authors and funding
9 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSelective immune adsorption (SIA) is an emerging method for treating immune-mediated neurological diseases, given its superior safety profile compared to plasma exchange (PEX). However, the available literature concerning Multiple Sclerosis includes no cases of SIA applied to steroid-refractory rebound after Fingolimod discontinuation. CASE PRESENTATION: Here we report the case of a 32-year-old woman suffering from multiple sclerosis treated with Fingolimod and admitted to a Multiple Sclerosis Centre after drug discontinuation due to the occurrence of lymphopenia. During the few weeks preceding admission, the patient experienced progressive and severe neurological deterioration that did not respond to an initial cycle of pulsed high doses of intravenous 6-methyl prednisolone (IVMP). Given the ineffectiveness of a second cycle of IVMP, the patient was treated with plasma immunoadsorption, leading to dramatic functional recovery. The patient then started a neuro-rehabilitation program. About one month after the final SIA procedure the patient started Natalizumab-based therapy, while maintaining a stable neurological condition. We noted significant modification of C3/C4 complement components and total gamma globulin concentrations (IgG) during SIA.
conclusionsOur observations show that however serious, steroid-refractory neurological deterioration occurring after Fingolimod discontinuation in multiple sclerosis can be treated with selective immune-adsorption therapy which thus represents a good alternative in these cases. It could be speculated that this clinical condition was associated with pattern II of demyelination, given the good response to a form of treatment that acts on autoantibodies. Thus, SIA represented an effective therapeutic strategy for this case of relapsed MS as steroid-resistent rebound post Fingolimod cessation.
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