Abstract
We report a case of bilateral macular edema (ME) within 10 days of starting fingolimod 0.5 mg therapy in a patient with Multiple Sclerosis (MS). The complication resolved without treatment as demonstrated by sequential Optical Coherence Tomography (OCT). Fingolimod is a sphingosine-1-phosphate receptor modulator that reduces lymphocyte presence in the CNS. In pivotal trials, ME, a known complication of fingolimod, typically occurred unilaterally with onset at approximately 3 months. A 60 y/o AA female, diagnosed with MS in 1977, started oral fingolimod treatment on 05/31/2011. Baseline screening with OCT and ophthalmology evaluation showed no ME. On 06/10, she developed bilateral blurry vision and discontinued fingolimod. On 06/27, OCT revealed severe bilateral ME. Later OCT exams showed a progressive decrease in Central Foveal Thickness (CFT) and Macular Volume (MV), without specific treatment other than discontinuation of fingolimod. On 7/27, CFT, MV, and Visual Acuity (VA) were similar to baseline. This is the first reported case of bilateral, early onset ME following fingolimod treatment at the current FDA-approved dose of 0.5 mg. Diabetes, a known risk factor for ME, may have contributed to her early, bilateral involvement. Our case provides further support for earlier OCT, in conjunction with ophthalmic examinations, for at-risk patients on fingolimod, and suggests that cessation of fingolimod may be associated with resolution of ME.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 256-258 |
| Number of pages | 3 |
| Journal | Multiple Sclerosis and Related Disorders |
| Volume | 2 |
| Issue number | 3 |
| DOIs | |
| State | Published - Jul 1 2013 |
| Externally published | Yes |
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Keywords
- Macular edema
- Multiple sclerosis
- Optic nerve
- Optical coherence tomography
- Retina
- Vision loss
ASJC Scopus subject areas
- Clinical Neurology
- Neurology
Cite this
Severe early bilateral macular edema following fingolimod therapy. / Coppes, Oscar Jim Michael; Gutierrez, Ismael; Reder, Anthony T.; Ksiazek, Susan; Bernard, Jacqueline.
In: Multiple Sclerosis and Related Disorders, Vol. 2, No. 3, 01.07.2013, p. 256-258.Research output: Contribution to journal › Article
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TY - JOUR
T1 - Severe early bilateral macular edema following fingolimod therapy
AU - Coppes, Oscar Jim Michael
AU - Gutierrez, Ismael
AU - Reder, Anthony T.
AU - Ksiazek, Susan
AU - Bernard, Jacqueline
PY - 2013/7/1
Y1 - 2013/7/1
N2 - We report a case of bilateral macular edema (ME) within 10 days of starting fingolimod 0.5 mg therapy in a patient with Multiple Sclerosis (MS). The complication resolved without treatment as demonstrated by sequential Optical Coherence Tomography (OCT). Fingolimod is a sphingosine-1-phosphate receptor modulator that reduces lymphocyte presence in the CNS. In pivotal trials, ME, a known complication of fingolimod, typically occurred unilaterally with onset at approximately 3 months. A 60 y/o AA female, diagnosed with MS in 1977, started oral fingolimod treatment on 05/31/2011. Baseline screening with OCT and ophthalmology evaluation showed no ME. On 06/10, she developed bilateral blurry vision and discontinued fingolimod. On 06/27, OCT revealed severe bilateral ME. Later OCT exams showed a progressive decrease in Central Foveal Thickness (CFT) and Macular Volume (MV), without specific treatment other than discontinuation of fingolimod. On 7/27, CFT, MV, and Visual Acuity (VA) were similar to baseline. This is the first reported case of bilateral, early onset ME following fingolimod treatment at the current FDA-approved dose of 0.5 mg. Diabetes, a known risk factor for ME, may have contributed to her early, bilateral involvement. Our case provides further support for earlier OCT, in conjunction with ophthalmic examinations, for at-risk patients on fingolimod, and suggests that cessation of fingolimod may be associated with resolution of ME.
AB - We report a case of bilateral macular edema (ME) within 10 days of starting fingolimod 0.5 mg therapy in a patient with Multiple Sclerosis (MS). The complication resolved without treatment as demonstrated by sequential Optical Coherence Tomography (OCT). Fingolimod is a sphingosine-1-phosphate receptor modulator that reduces lymphocyte presence in the CNS. In pivotal trials, ME, a known complication of fingolimod, typically occurred unilaterally with onset at approximately 3 months. A 60 y/o AA female, diagnosed with MS in 1977, started oral fingolimod treatment on 05/31/2011. Baseline screening with OCT and ophthalmology evaluation showed no ME. On 06/10, she developed bilateral blurry vision and discontinued fingolimod. On 06/27, OCT revealed severe bilateral ME. Later OCT exams showed a progressive decrease in Central Foveal Thickness (CFT) and Macular Volume (MV), without specific treatment other than discontinuation of fingolimod. On 7/27, CFT, MV, and Visual Acuity (VA) were similar to baseline. This is the first reported case of bilateral, early onset ME following fingolimod treatment at the current FDA-approved dose of 0.5 mg. Diabetes, a known risk factor for ME, may have contributed to her early, bilateral involvement. Our case provides further support for earlier OCT, in conjunction with ophthalmic examinations, for at-risk patients on fingolimod, and suggests that cessation of fingolimod may be associated with resolution of ME.
KW - Macular edema
KW - Multiple sclerosis
KW - Optic nerve
KW - Optical coherence tomography
KW - Retina
KW - Vision loss
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U2 - 10.1016/j.msard.2012.11.004
DO - 10.1016/j.msard.2012.11.004
M3 - Article
VL - 2
SP - 256
EP - 258
JO - Multiple Sclerosis and Related Disorders
JF - Multiple Sclerosis and Related Disorders
SN - 2211-0348
IS - 3
ER -