Tanaka Masami
Multiple Sclerosis Center, National Hospital Organization, Utano National Hospital.
Rinsho Shinkeigaku. 2016 Apr 28;56(4):270-2. doi: 10.5692/clinicalneurol.cn-000809. Epub 2016 Mar 24.
Fingolimod, a sphingosine-1-phosphate receptor modulator, inhibits the egress of CCR7-positive lymphocytes, including encephalitogenic lymphocytes, from lymph nodes and may sometimes cause lymphopenia. A recent study reported that varicella zoster virus reactivation occurred in the saliva of 20% of multiple sclerosis (MS) patients treated with fingolimod. I compared the risk of developing herpes zoster between 32 MS patients treated with fingolimod (FTY-MS) and 45 patients, including those with neuromyelitis optica spectrum disorder, horizontal hemianopsia without anti-aquaporin-4 antibodies, and myelitis with anti-myelin oligodendrocyte glycoprotein antibodies, treated with tacrolimus (TCR-NMO). The risk of developing herpes zoster in FTY-MS (40/1,000 patient-years) was significantly higher than that in TCR-NMO (6/1,000 patient-years) (P < 0.0001, odds ratio: 6.90). The incidence of herpes zoster of patients with rheumatoid arthritis treated with Tofacitinib in Asian countries has been shown to be higher than those of patients in the United States or European countries. It may be better to pay more attention to develop herpes zoster in Japanese MS patients treated with fingolimod.
芬戈莫德是一种鞘氨醇-1-磷酸受体调节剂，可抑制包括致脑炎性淋巴细胞在内的CCR7阳性淋巴细胞从淋巴结中流出，有时可能导致淋巴细胞减少。最近一项研究报告称，接受芬戈莫德治疗的多发性硬化症（MS）患者中有20%的人唾液中出现水痘带状疱疹病毒再激活。我比较了32例接受芬戈莫德治疗的MS患者（FTY-MS）和45例接受他克莫司治疗的患者（TCR-NMO）发生带状疱疹的风险，后者包括视神经脊髓炎谱系障碍患者、无抗水通道蛋白-4抗体的水平性偏盲患者以及有抗髓鞘少突胶质细胞糖蛋白抗体的脊髓炎患者。FTY-MS患者发生带状疱疹的风险（40/1000患者年）显著高于TCR-NMO患者（6/1000患者年）（P<0.0001，比值比：6.90）。在亚洲国家，接受托法替布治疗的类风湿关节炎患者发生带状疱疹的发生率已被证明高于美国或欧洲国家的患者。对于接受芬戈莫德治疗的日本MS患者，可能最好更关注发生带状疱疹的情况。
