Phase II study of oral fingolimod (FTY720) in multiple sclerosis: 3-year results. Mult Scler

Department of Neurology, Università Vita-Salute San Raffaele, Milan, Italy.
Multiple Sclerosis (Impact Factor: 4.86). 12/2009; 16(2):197-207. DOI: 10.1177/1352458509357065
Source: PubMed

ABSTRACT In a 6-month, placebo-controlled trial, oral fingolimod (FTY720) 1.25 or 5.0 mg, once daily, significantly reduced MRI inflammatory activity and annualized relapse rate compared with placebo in patients with relapsing multiple sclerosis (MS). The objectives were to monitor the 36-month, interim efficacy and safety results of the ongoing extension of this study. In the extension (months 7-36), placebo-treated patients were re-randomized to either dose of fingolimod; fingolimod-treated patients continued at the same dose. During months 15-24, all patients receiving fingolimod 5.0 mg switched to 1.25 mg. Of the 250 patients who entered the extension study, 173 (69%) continued to month 36. Most patients were free from gadolinium-enhanced lesions (88-89%) or new T2 lesions (70-78%) at month 36. Patients receiving continuous fingolimod treatment had sustained low annualized relapse rates of 0.20-0.21, and 68-73% remained relapse-free at month 36. Over 36 months, nasopharyngitis (34%), headache (30%), fatigue (19%) and influenza (18%) were the most commonly reported adverse events. Pulmonary function remained stable and blood pressure was stable after an initial increase (3-5 mmHg) during the first 6 months of fingolimod treatment; serious adverse events included infections and skin cancer. The low MRI and clinical disease activity at 6 months were maintained at 36 months with fingolimod, which was generally well tolerated by most patients. The efficacy and safety of oral fingolimod are being further evaluated in a large phase III MS study programme.

  • Source
    • "In clinical practice, due to its presumed superiority over interferon beta, fingolimod is one of the first line therapeutic choices for highly active RRMS. Besides the positive effect on clinical outcome, previous clinical trials (Kappos et al., 2006; Comi et al., 2010) as well as the following phase III studies FREEDOMS, TRANSFORMS and FREEDOMS II have shown effects of fingolimod on magnetic resonance imaging (MRI) outcomes: Gadolinium (Gd) enhanced lesions, the morphological correlates of clinical as well as subclinical relapses, were reduced in the fingolimod treatment group compared to the patients receiving interferon beta-1a or placebo. Gd enhancement indicates BBB leakage, which is one of the initial steps in the pathophysiological cascade resulting in a MS plaque. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Sphingolipids are a fascinating class of signaling molecules derived from the membrane lipid sphingomyelin. They show abundant expression in the brain. Complex sphingolipids such as glycosphingolipids (gangliosides and cerebrosides) regulate vesicular transport and lysosomal degradation and their dysregulation can lead to storage diseases with a neurological phenotype. More recently, simple sphingolipids such ceramide, sphingosine and sphingosine 1-phosphate (S1P) were discovered to signal in response to many extracellular stimuli. Forming an intricate signaling network, the balance of these readily interchangeable mediators is decisive for cell fate under stressful conditions. The immunomodulator fingolimod is the prodrug of an S1P receptor agonist. Following receptor activation, the drug leads to downregulation of the S1P1 receptor inducing functional antagonism. As the first drug to modulate the sphingolipid signaling pathway, it was marketed in 2010 for the treatment of multiple sclerosis (MS). At that time, immunomodulation was widely accepted as the key mechanism of fingolimod's efficacy in MS. But given the excellent passage of this lipophilic compound into the brain and its massive brain accumulation as well as the abundant expression of S1P receptors on brain cells, it is conceivable that fingolimod also affects brain cells directly. Indeed, a seminal study showed that the protective effect of fingolimod in experimental autoimmune encephalitis (EAE), a murine MS model, is lost in mice lacking the S1P1 receptor on astrocytes, arguing for a specific role of astrocytic S1P signaling in MS. In this review, we discuss the role of sphingolipid mediators and their metabolizing enzymes in neurologic diseases and putative therapeutic strategies arising thereof.
    Frontiers in Cellular Neuroscience 09/2014; 8:283. DOI:10.3389/fncel.2014.00283 · 4.18 Impact Factor
  • Source
    • "Phase II and the aforementioned phase III clinical trials have shown that FTY720 is generally well tolerated and the reported adverse effects are, further to adverse effects due to immunosuppression, also of a cardiovascular nature. Besides transient effects on heart rate (bradycardia ) and atrioventricular conduction, a moderate increase in BP of approximately 3–5 mmHg in 4–6% of treated patients was observed that persisted during treatment (Cohen et al., 2010; Comi et al., 2010; Kappos et al., 2010). In addition , one case of severe peripheral arterial vasospasm was reported in a patient after 7 days of FTY720 treatment (Schwarz et al., 2010). "
    [Show abstract] [Hide abstract]
    ABSTRACT: FTY720 (Fingolimod) is a recently approved orally administered drug for the treatment of multiple sclerosis. Phase II and III clinical trials have demonstrated that this drug modestly increases BP. We previously showed that inhibition of sphingosine kinase increases vascular tone and BP in hypertensive, but not normotensive rats. Since FTY720 is reported to have inhibitory effects on sphingosine kinase, we investigated whether FTY720 increases vascular tone and BP only in hypertensive rats via this mechanism. The contractile and BP modulating effects of FTY720 were studied in vivo and ex vivo (wire myography) in age-matched normotensive Wistar Kyoto (WKY) rats and spontaneously hypertensive rats (SHRs). Oral administration of FTY720 induced an increase in mean arterial pressure in SHR, whereas a decrease in BP was observed in WKY rats, as measured 24 h after administration. Similar to the sphingosine kinase inhibitor dimethylsphingosine (DMS), FTY720 induced large contractions in isolated carotid arteries from SHR, but not in those from WKY. In contrast, the phosphorylated form of FTY720 did not induce contractions in isolated carotid arteries from SHR. FTY720-induced contractions were inhibited by endothelium denudation, COX and thromboxane synthase inhibitors, and by thromboxane receptor antagonism, indicating that (like DMS-induced contractions) they were endothelium-dependent and mediated by thromboxane A₂. These data demonstrate that FTY720 increases vascular tone and BP only in hypertensive rats, most likely as a result of its inhibitory effect on sphingosine kinase.
    British Journal of Pharmacology 01/2012; 166(4):1411-8. DOI:10.1111/j.1476-5381.2012.01865.x · 4.99 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A report is made on a study, of the "average voice" resulting in an electronic synthetic speech signal suitable for testing mobile radio systems in particular. An analysis of the frequency and level distributions, with respect to time, of a large number of "talkers" precedes a description of the synthetic voice signal. The design outline of a device, which could produce such a signal, is suggested along with comments about its use.
    Vehicular Technology Conference, 1966. 17th IEEE; 01/1967
Show more