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Volume : 25 Issue : 4 Year : 2019

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Fingolimod Therapy for Pediatric Relapsing Remitting Multiple Sclerosis: Real Life Study [Turk J Neurol]
Turk J Neurol. Ahead of Print: TJN-77010

Fingolimod Therapy for Pediatric Relapsing Remitting Multiple Sclerosis: Real Life Study

Canan Duman İlki1, Tuncay Gündüz1, Murat Kürtüncü1, Zuhal Yapici1, Serra Sencer2, Mefküre Eraksoy1
1Istanbul University, Istanbul Medical Faculty, Department of Neurology, Istanbul
2Istanbul University, Istanbul Medical Faculty, Department of Radiology, Istanbul

Objective: Clinical studies in childhood multiple sclerosis (MS) are very limited compared to adults. Although the first-line injection therapies are well tolerated in this patient group, there are difficulties in the long-term treatment of patients due to the difficulty and adverse effects of injection for children. Oral therapies are better tolerated for use and side effects compared to injection therapies. This study aimed to evaluate the clinical features and treatment outcomes of patients with relapsing-remitting MS (RRMS) who received fingolimod treatment under 18.
Materials and Methods: In this study, clinical records of 22 RRMS patients who had fingolimod treatment were examined. The patients were prospectively followed-up between February 2015 and December 2018. Patients were evaluated in terms of relapse rate, EDSS scores, brain and cervical magnetic resonance imaging (MRI) and side effects before and after fingolimod treatment.
Results: The median ages of 13 (59%) female and 9 (41%) male patients were 18 (range: 10-21). The median duration of the patients receiving fingolimod treatment was 2.5 (range: 1.3-3.9) years. The median age of onset of the disease was 13 (range: 8-17). Fifteen patients (68%) received a first-line treatment prior to fingolimod. The reason for switching to fingolimod was inefficacy in 33%, side effects in 40% and both in 27%. In 32% of patients, fingolimod was started as first-line treatment. A total of three patients had recurrent relapses under treatment with fingolimod. The median annualized relapse rate (ARR) before fingolimod was 1.9 (range: 0.3-8.0), while the ARR with fingolimod was 0 (range: 0-2.0) (Wilcoxon's signed-rank test; p<0.001). The median EDSS was 1.5 (range: 1.0-4.0) before fingolimod, while the EDSS after treatment was 1.5 (range: 1.0 to 5.0) (Wilcoxon's signed rank test; p=0.3). None of the patients had any side effects during the first dose monitoring.
Conclusion: Our study shows that fingolimod is an effective and safe treatment alternative in childhood MS.


Keywords: Child and adolescent multiple sclerosis, fingolimod, real-world evidence




Corresponding Author: Canan Duman İlki, Türkiye


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