Background and rationale for mechanism of action, efficacy, and safety of fingolimod (Gilenya), the first oral therapy for remitting-relapsing multiple sclerosis: with special emphasis upon visual safety.

Wills Eye Institute Neuro-Ophthalmology Service, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Current opinion in ophthalmology (Impact Factor: 2.49). 09/2011; 22(6):447-50. DOI: 10.1097/ICU.0b013e32834be03b
Source: PubMed
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    ABSTRACT: Multiple sclerosis (MS) is a demyelinating disease of the central nervous system and is the common cause of optic neuritis. Fingolimod, an immunosuppressive agent, is used in MS to prevent acute exacerbations. We report a case of relapsing-remitting MS treated with fingolimod. The patient presented with an acute decrease in vision in the left eye. Eye examination showed clinical macular edema (ME) in the left eye, which was confirmed on fluorescein angiogram and optical coherence tomography (OCT). After discontinuation of fingolimod and treatment with topical corticosteroid medication, there was complete resolution of the ME. The ME as a side-effect of fingolimod is reversible after discontinuing, which was seen on OCT.
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    ABSTRACT: The pathophysiology of multiple sclerosis (MS) is typically characterised by inflammation and demyelination leading to neurodegeneration, which is associated with disability and the progressive stages of MS. The visual system is a valuable tool for studying neurodegeneration and potential neuroprotection in the central nervous system due to its ease of accessibility. Optical coherence tomography (OCT) is a non-invasive tool, which can be used to measure the thickness of the retinal nerve fibre layer (RNFL). The thickness of RNFL is reduced following the development of MS and optic neuritis and can therefore be used as a correlate of global axonal loss. OCT is currently being investigated as a structural outcome measure for neuroprotective clinical trials of MS. This review describes the relationship between MS and optic neuritis and the associated RNFL thinning, the technology and advancements of OCT, the role of OCT in clinical trials for new neuroprotective therapies in MS and the future role of OCT in MS research.
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