University of Chicago, Department of Neurology, Chicago, IL, United States.
University of Chicago, Department of Neurology, Chicago, IL, United States.
Mult Scler Relat Disord. 2016 Sep;9:158-62. doi: 10.1016/j.msard.2016.07.015. Epub 2016 Aug 4.
Fingolimod is a disease-modifying agent used in the treatment of relapsing/remitting multiple sclerosis. In MS clinical studies, the overall rate of infections in fingolimod group was overall similar to placebo, except for slightly more common lower respiratory tract infections and to a lesser extent HSV. Recently, an increasing number of cryptococcal infections associated with a long-term use of this medication have been reported.
We reviewed literature for cases of cryptococcal infection associated with the use of fingolimod and reported a case at our institution, as well as carefully evaluated the established immune mechanisms of the medication and discussed new insights into its short-term and long-term immunologic effects that may become important in the context of risk of infection.
Unique characteristics of cryptococcal pathogen, its immune escape mechanisms, its ability to establish a latent infection with a potential for later reactivation, fingolimod's effects on many lines of immune system, both quantitatively and qualitatively, duration of therapy, and long-term effects of fingolimod, not previously described, in conjunction with effects of natural immunosenescence of the patient population, that appears to be most at risk, may be meaningful in further understanding the risk of infection with long-term use of fingolimod in people of older age.
芬戈莫德是一种用于治疗复发缓解型多发性硬化症的疾病修正治疗药物。在多发性硬化症的临床研究中，与安慰剂组相比，芬戈莫德组的总体感染率总体相似，除了下呼吸道感染略为常见，以及单纯疱疹病毒感染程度较轻。最近，越来越多与长期使用这种药物相关的隐球菌感染病例被报道。
我们对与使用芬戈莫德相关的隐球菌感染病例进行了文献复习，并报告了我们机构的一个病例，同时仔细评估了该药物的既定免疫机制，并讨论了其短期和长期免疫效应的新见解，这些见解可能在感染风险方面变得很重要。
隐球菌病原体的独特特征、其免疫逃逸机制、建立潜伏感染的能力以及随后重新激活的潜力、芬戈莫德对免疫系统的许多方面的影响，无论是在数量上还是在质量上、治疗持续时间以及以前未描述的芬戈莫德的长期效应，再加上患者人群的自然免疫衰老的影响，似乎在进一步了解年龄较大的人群长期使用芬戈莫德的感染风险方面具有重要意义。
