Unexpected high multiple sclerosis activity after switching from fingolimod to alemtuzumab

• Published in: Multiple sclerosis and related disorders Vol. 25; pp. 216 - 218
• Main Authors: Bernard-Valnet, Raphaël, Pignolet, Béatrice, Biotti, Damien, Ciron, Jonathan, Lafontan, Jean François, Dumas, Hervé, Bonneville, Fabrice, Brassat, David
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-10-2018
• Subjects: Alemtuzumab; Alemtuzumab - adverse effects; Antineoplastic Agents, Immunological - adverse effects; Drug Substitution - adverse effects; Female; Fingolimod; Fingolimod Hydrochloride - therapeutic use; Humans; Immunosuppressive Agents - therapeutic use; Magnetic Resonance Imaging; Middle Aged; Multiple Sclerosis; Multiple Sclerosis - diagnostic imaging; Multiple Sclerosis - drug therapy; Multiple Sclerosis - epidemiology; Rebound; Multiple Sclerosis; Rebound; Alemtuzumab; Fingolimod
• ISSN: 2211-0348; 2211-0356
• DOI: 10.1016/j.msard.2018.08.006

•Fingolimod withdrawal could be followed by severe relapse despite Alemtuzumab introduction.•Several immunological mechanisms could underlie this phenomenon including prolonged sequestration of activated lymphocyte and/or paradoxical effect of alemtuzumab.•This case highlights challenges in sequential use of immunotherapies in multiple sclerosis.
Unexpected high disease activity (UHDA) after Fingolimod withdrawal has recently become a controversial concern for physicians. Here, we report the case of a patient with severe exacerbation of MS after switching from Fingolimod to Alemtuzumab treatment. This UHDA despite profound lymphopenia raised the question of the management of sequential use of biotherapies such as Fingolimod and Alemtuzumab in MS.