Heart rate variability decreases after 3 months of sustained treatment with fingolimod

Heart rate variability decreases after 3 months of sustained treatment with fingolimod

The objective is to prospectively investigate short- and mid-term changes of heart rate variability (HRV) in patients with relapsing–remitting multiple sclerosis (RRMS), being started on fingolimod. In this prospective clinical trial, patient ( n  = 33) with RRMS starting treatment with fingolimod u...

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Bibliographic Details
Published in:Journal of neurology Vol. 264; no. 11; pp. 2313 - 2317
Main Authors: Vehoff, Jochen, Haegele-Link, Stefan, Humm, Andrea, Kaegi, Georg, Mueller, Stefanie Karin, Sauter, Rafael, Tettenborn, Barbara Elisabeth, Hundsberger, Thomas
Format: Journal Article
Language:English
Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-11-2017
Springer Nature B.V
Subjects:
Adolescent
Adult
Blood pressure
Blood Pressure - drug effects
Cardiac arrhythmia
Fatigue
Female
Fingolimod Hydrochloride - adverse effects
Follow-Up Studies
Heart Diseases - chemically induced
Heart rate
Heart Rate - drug effects
Humans
Immunosuppressive Agents - adverse effects
Male
Medicine
Medicine & Public Health
Middle Aged
Multiple sclerosis
Multiple Sclerosis, Relapsing-Remitting - drug therapy
Multiple Sclerosis, Relapsing-Remitting - physiopathology
Neurology
Neuroradiology
Neurosciences
Norepinephrine
Original Communication
Retrospective Studies
Time Factors
Valsalva Maneuver - drug effects
Young Adult
Multiple sclerosis
Fingolimod
Autonomic nervous system
Heart rate variability
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Summary:The objective is to prospectively investigate short- and mid-term changes of heart rate variability (HRV) in patients with relapsing–remitting multiple sclerosis (RRMS), being started on fingolimod. In this prospective clinical trial, patient ( n  = 33) with RRMS starting treatment with fingolimod underwent a time-domain-based analysis of HRV (breathing at rest, deep breath, and in response to the Valsalva maneuver) shortly before, 4.5 h and 3 months after first intake. Blood pressure changes after the Valsalva maneuver were used as a marker of the sympathetic noradrenergic system. We used a non-invasive continuous beat-to-beat heart rate and blood pressure monitoring. In addition, the Fatigue Severity Scale and the refined and abbreviated Composite Autonomic Symptom Score were applied. Significant changes in HRV in RRMS patients, following treatment with fingolimod, were detected. After an initial increase in HRV, measured 4.5 h after the first intake of fingolimod, a substantial decrease in HRV occurred within 3 months on continuous treatment. There is a growing body of evidence for short-term cardiovascular side effects in continuous treatment with fingolimod, driven by the ANS. The mechanisms and the clinical relevance of the observed changes in HRV need further evaluation, especially in longer and larger prospective studies.
Bibliography:ObjectType-Article-2
SourceType-Scholarly Journals-1
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ISSN:0340-5354
1432-1459
DOI:10.1007/s00415-017-8636-3