停用芬戈莫德后多发性硬化症的严重恶化。
Severe Exacerbation of Multiple Sclerosis Following Withdrawal of Fingolimod.
机构信息
Universidade Metropolitana de Santos, Santos, SP, Brazil.
MS and Headache Research, Santos, SP, Brazil.
出版信息
Clin Drug Investig. 2019 Sep;39(9):909-913. doi: 10.1007/s40261-019-00804-6.
BACKGROUND
Fingolimod is an effective therapy for multiple sclerosis (MS). Isolated reports of very aggressive MS rebound after discontinuation of fingolimod are drawing neurologists' attention to this potentially severe complication of the drug.
OBJECTIVE
Our objective was to collect literature data on cases of MS rebound following fingolimod withdrawal. In addition, we report six new cases of this adverse event in Brazil.
METHODS
We carried out a systematic review of published data on cases of MS rebound after fingolimod was discontinued. In addition, the study reports a retrospective data series of Brazilian patients presenting this rebound reaction.
RESULTS
Twenty papers have been published reporting on 52 patients with severe MS rebound after fingolimod withdrawal. Six new patients are included in the present paper, all of them with aggressive rebound and accumulated disability sequelae.
CONCLUSION
We recommend gradual discontinuation of fingolimod with replacement by other treatment. The washout period should not exceed 4 weeks.
背景
芬戈莫德是多发性硬化症（MS）的有效治疗药物。停用芬戈莫德后出现非常严重的 MS 反弹的个别报告引起了神经科医生对该药物潜在严重并发症的关注。
目的
我们的目的是收集有关停用芬戈莫德后 MS 反弹病例的文献数据。此外，我们还报告了巴西的六例该不良反应的新病例。
方法
我们对已发表的关于停用芬戈莫德后 MS 反弹病例的数据进行了系统回顾。此外，本研究报告了巴西出现这种反弹反应的患者的回顾性数据系列。
结果
已有 20 篇论文报道了 52 例停用芬戈莫德后出现严重 MS 反弹的患者。本论文还纳入了 6 例新患者，他们都有严重的反弹和累积残疾后遗症。
结论
我们建议逐渐停用芬戈莫德并用其他治疗方法替代。洗脱期不应超过 4 周。
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