Takahashi Kazuya
Department of Neurology, Hokuriku Brain and Neuromuscular Disease Center, National Hospital Organization Iou Hospital, Kanazawa, Japan.
J Clin Neurosci. 2019 May;63:91-94. doi: 10.1016/j.jocn.2019.01.034. Epub 2019 Feb 14.
Of the 19 cases of fingolimod-associated progressive multifocal leukoencephalopathy (PML) reported worldwide by the end of 2017, 4 cases were from Japan. This may indicate that fingolimod sensitivity is higher in the Japanese population than in the western population because the fingolimod dosage used for the prevention of multiple sclerosis (MS) is the same in both populations. Therefore, the laboratory data of nine patients with MS receiving fingolimod treatment for more than 2 years were retrospectively collected. Moreover, the effect of drug holiday was compared between five patients who underwent at least 3 months of dosage reduction via drug holiday after receiving fingolimod for more than 2 years and three patients who underwent drug holiday after receiving fingolimod for less than 2 years. The total, CD3(+), CD4(+), C19(+) lymphocyte counts, the CD4(+)/CD8(+) cell ratio, and the serum IgG concentrations were similar between Japanese patients with MS receiving fingolimod for more than 2 years and Western patients from the previous reports. Recovery of lymphocyte counts in the peripheral blood after fingolimod dosage reduction was worse in some MS patients who received long-term fingolimod treatment than in MS patients who received short-term fingolimod treatment. My findings indicate that the currently used fingolimod dosage may be too high for some Japanese MS patients receiving long-term fingolimod treatment.
截至2017年底，全球报告的19例与芬戈莫德相关的进行性多灶性白质脑病（PML）病例中，有4例来自日本。这可能表明，日本人群对芬戈莫德的敏感性高于西方人群，因为在这两个人群中，用于预防多发性硬化症（MS）的芬戈莫德剂量是相同的。因此，我们回顾性收集了9例接受芬戈莫德治疗超过2年的MS患者的实验室数据。此外，还比较了5例在接受芬戈莫德治疗超过2年后通过药物假期至少减少剂量3个月的患者与3例在接受芬戈莫德治疗不到2年后进行药物假期的患者的药物假期效果。接受芬戈莫德治疗超过2年的日本MS患者与先前报告中的西方患者之间的总淋巴细胞计数、CD3(+)、CD4(+)、C19(+)淋巴细胞计数、CD4(+)/CD8(+)细胞比率和血清IgG浓度相似。在一些接受长期芬戈莫德治疗的MS患者中，芬戈莫德剂量减少后外周血淋巴细胞计数的恢复情况比接受短期芬戈莫德治疗的MS患者更差。我的研究结果表明，对于一些接受长期芬戈莫德治疗的日本MS患者来说，目前使用的芬戈莫德剂量可能过高。
