Rebound of disease activity after withdrawal of fingolimod (FTY720) treatment

Arch Neurol. 2012 Feb;69(2):262-4. doi: 10.1001/archneurol.2011.1057.


Background: The oral sphingosine-1-phosphate receptor modulator fingolimod (FTY720) was recently approved for the treatment of relapsing-remitting multiple sclerosis. To date, data about a possible recurrence of disease activity after discontinuation of fingolimod treatment are scarce.

Objective: To describe a patient who discontinued fingolimod treatment after a local malignant melanoma was diagnosed. Three months after cessation, he had a striking rebound of multiple sclerosis activity.

Design: Case report and review of literature.

Setting: Institute of Clinical Neuroimmunology, Ludwig-Maximilians-University, Munich, Germany.

Patient: A 45-year-old man diagnosed as having relapsing-remitting multiple sclerosis.

Main outcome measures: Multiple sclerosis disease activity including annual relapse rate, Expanded Disability Status Scale score, and number of gadolinium-enhancing lesions on magnetic resonance imaging before, during, and after treatment with fingolimod.

Results: Three months after discontinuation of treatment with fingolimod, the patient experienced a severe relapse, with Expanded Disability Status Scale score progression from 2.5 to 4.5. On brain and spinal magnetic resonance imaging, he showed a rebound of disease activity, with a drastic increase of gadolinium-enhancing lesions (>20).

Conclusions: Two aspects relevant to any newly approved multiple sclerosis treatment with immunomodulatory properties are highlighted with this case: first, possible rebound of disease activity after discontinuation; second, the occurrence of a tumor as a possible treatment-related complication.

Publication types

  • Case Reports

MeSH terms

  • Brain / pathology
  • Disability Evaluation
  • Disease Progression
  • Fingolimod Hydrochloride
  • Humans
  • Immunologic Factors / therapeutic use*
  • Interferon-beta / therapeutic use
  • Magnetic Resonance Imaging
  • Male
  • Melanoma / complications*
  • Middle Aged
  • Multiple Sclerosis, Relapsing-Remitting / complications
  • Multiple Sclerosis, Relapsing-Remitting / drug therapy*
  • Multiple Sclerosis, Relapsing-Remitting / pathology
  • Propylene Glycols / therapeutic use*
  • Recurrence
  • Sphingosine / analogs & derivatives*
  • Sphingosine / therapeutic use
  • Treatment Outcome


  • Immunologic Factors
  • Propylene Glycols
  • Interferon-beta
  • Fingolimod Hydrochloride
  • Sphingosine