Effect of Fingolimod on Platelet Count Among Multiple Sclerosis Patients

Overview

Journal Int J Prev Med

Date 2016 Feb 23

PMID 26900439

Citations 15

Authors

Mehrdad Farrokhi

Ali Amani Beni

Masoud Etemadifar

Ali Rezaei

Leah Rivard

Aryan Rafiee Zadeh

Nahid Sedaghat

Milad Ghadimi

Affiliations

Soon will be listed here.

Abstract

Background: While many studies have previously focused on fingolimod's effect on immune cells, the effect it has on circulating and local central nervous system platelets (Plts) has not yet been investigated. This study will elucidate what effects fingolimod treatment has on multiple sclerosis (MS) patients' plasma Plt levels. In addition, it will propose possible reasoning for these effects and suggest further investigation into this topic.

Methods: This quasi-experimental study used patients from the Isfahan Multiple Sclerosis Society to produce a subject pool of 80 patients, including 14 patients who ceased fingolimod use due to complications. The patients had their blood analyzed to determine Plt levels both 1-month prior to fingolimod treatment and 1-month after fingolimod treatment had been started.

Results: The mean level of Plts before initiation of fingolimod therapy (Plt1) among these MS patients was 256.53 ± 66.26. After 1-month of fingolimod treatment, the Plt level yielded an average of 229.96 ± 49.67 (Plt2). This number is significantly lower than the average Plt count before treatment (P < 0.01).

Conclusions: MS patients taking oral fingolimod treatment may be at risk for side-effects caused by low Plt levels. This may not be a factor for patients with higher or normal Plt levels. However, a patient with naturally low Plt levels may experience a drop below the normal level and be at risk for excessive bleeding. In addition to these possible harmful side-effects, the decreased Plt population may pose positive effects for MS patients.

Citing Articles

Effect of Silybum Marianum on Reduction of Chemotherapy-Induced Peripheral Neurotoxicity with Cisplatin.

Gholami A, Ansari H, Dadkhah A Adv Biomed Res. 2024; 13:21.

PMID: 38808323 PMC: 11132193. DOI: 10.4103/abr.abr_365_21.

Evaluation of the Relative Frequency of Epstein-Barr Virus Infection in Patients with Recurrent Breast Cancer Compared with Patients with Nonrecurrent Breast Cancer.

Eshraghi Samani R, Safaee M, Nematollahi P, Amraei B Adv Biomed Res. 2023; 12:34.

PMID: 37057233 PMC: 10086641. DOI: 10.4103/abr.abr_381_21.

The impact of sphingosine-1-phosphate receptor modulators on COVID-19 and SARS-CoV-2 vaccination.

Baker D, Forte E, Pryce G, Kang A, James L, Giovannoni G Mult Scler Relat Disord. 2022; 69:104425.

PMID: 36470168 PMC: 9678390. DOI: 10.1016/j.msard.2022.104425.

Comparing the Effectiveness of Bupivacaine Administration through Chest Tube and Intercostal Blockage in Patients with Rib Fractures.

Nasr-Esfahani M, Kolahdouzan M, Pourazari P, Yazdani E Adv Biomed Res. 2022; 11:66.

PMID: 36325169 PMC: 9621344. DOI: 10.4103/abr.abr_50_21.

Platelet-Derived S1P and Its Relevance for the Communication with Immune Cells in Multiple Human Diseases.

Tolksdorf C, Moritz E, Wolf R, Meyer U, Marx S, Bien-Moller S Int J Mol Sci. 2022; 23(18).

PMID: 36142188 PMC: 9499465. DOI: 10.3390/ijms231810278.

References

Wang F, Tan W, Guo D, He S . Reduction of CD4 positive T cells and improvement of pathological changes of collagen-induced arthritis by FTY720. Eur J Pharmacol. 2007; 573(1-3):230-40. DOI: 10.1016/j.ejphar.2007.07.029. View

Brinkmann V, Billich A, Baumruker T, Heining P, Schmouder R, Francis G . Fingolimod (FTY720): discovery and development of an oral drug to treat multiple sclerosis. Nat Rev Drug Discov. 2010; 9(11):883-97. DOI: 10.1038/nrd3248. View

Singer B . Initiating oral fingolimod treatment in patients with multiple sclerosis. Ther Adv Neurol Disord. 2013; 6(4):269-75. PMC: 3707354. DOI: 10.1177/1756285613491520. View

Fragoso Y, Arruda C, Arruda W, Bidin Brooks J, Damasceno A, Damasceno C . The real-life experience with cardiovascular complications in the first dose of fingolimod for multiple sclerosis. Arq Neuropsiquiatr. 2014; 72(9):712-4. DOI: 10.1590/0004-282x20140102. View

Gregg D, Goldschmidt-Clermont P . Cardiology patient page. Platelets and cardiovascular disease. Circulation. 2003; 108(13):e88-90. DOI: 10.1161/01.CIR.0000086897.15588.4B. View

Huwiler A, Kolter T, Pfeilschifter J, Sandhoff K . Physiology and pathophysiology of sphingolipid metabolism and signaling. Biochim Biophys Acta. 2000; 1485(2-3):63-99. DOI: 10.1016/s1388-1981(00)00042-1. View

Muris A, Rolf L, Damoiseaux J, Koeman E, Hupperts R . Fingolimod in active multiple sclerosis: an impressive decrease in Gd-enhancing lesions. BMC Neurol. 2014; 14:164. PMC: 4236684. DOI: 10.1186/s12883-014-0164-5. View

Langer H, Chavakis T . Platelets and neurovascular inflammation. Thromb Haemost. 2013; 110(5):888-93. DOI: 10.1160/TH13-02-0096. View

Tarrason G, Auli M, Mustafa S, Dolgachev V, Domenech M, Prats N . The sphingosine-1-phosphate receptor-1 antagonist, W146, causes early and short-lasting peripheral blood lymphopenia in mice. Int Immunopharmacol. 2011; 11(11):1773-9. DOI: 10.1016/j.intimp.2011.07.004. View

10.

Soelberg Sorensen P . Effects of fingolimod in relapsing-remitting multiple sclerosis. Lancet Neurol. 2014; 13(6):526-7. DOI: 10.1016/S1474-4422(14)70067-5. View

11.

Sotnikov I, Veremeyko T, Starossom S, Barteneva N, Weiner H, Ponomarev E . Platelets recognize brain-specific glycolipid structures, respond to neurovascular damage and promote neuroinflammation. PLoS One. 2013; 8(3):e58979. PMC: 3608633. DOI: 10.1371/journal.pone.0058979. View

12.

Chun J, Hartung H . Mechanism of action of oral fingolimod (FTY720) in multiple sclerosis. Clin Neuropharmacol. 2010; 33(2):91-101. PMC: 2859693. DOI: 10.1097/WNF.0b013e3181cbf825. View

13.

Brinkmann V, Pinschewer D, Chiba K, Feng L . FTY720: a novel transplantation drug that modulates lymphocyte traffic rather than activation. Trends Pharmacol Sci. 2000; 21(2):49-52. DOI: 10.1016/s0165-6147(99)01419-4. View

14.

Gasperini C, Ruggieri S . Development of oral agent in the treatment of multiple sclerosis: how the first available oral therapy, fingolimod will change therapeutic paradigm approach. Drug Des Devel Ther. 2012; 6:175-86. PMC: 3414371. DOI: 10.2147/DDDT.S8927. View

15.

Knapp M, Lisowska A, Knapp P, Baranowski M . Dose-dependent effect of aspirin on the level of sphingolipids in human blood. Adv Med Sci. 2013; 58(2):274-81. DOI: 10.2478/ams-2013-0021. View

16.

Gross C, Baumgartner A, Rauer S, Stich O . Multiple sclerosis rebound following herpes zoster infection and suspension of fingolimod. Neurology. 2012; 79(19):2006-7. DOI: 10.1212/WNL.0b013e3182735d24. View

17.

Calabresi P, Radue E, Goodin D, Jeffery D, Rammohan K, Reder A . Safety and efficacy of fingolimod in patients with relapsing-remitting multiple sclerosis (FREEDOMS II): a double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Neurol. 2014; 13(6):545-56. DOI: 10.1016/S1474-4422(14)70049-3. View

18.

Langer H, Choi E, Zhou H, Schleicher R, Chung K, Tang Z . Platelets contribute to the pathogenesis of experimental autoimmune encephalomyelitis. Circ Res. 2012; 110(9):1202-10. PMC: 3382058. DOI: 10.1161/CIRCRESAHA.111.256370. View

19.

Knapp M, Zendzian-Piotrowska M, Blachnio-Zabielska A, Zabielski P, Kurek K, Gorski J . Myocardial infarction differentially alters sphingolipid levels in plasma, erythrocytes and platelets of the rat. Basic Res Cardiol. 2012; 107(6):294. PMC: 3505520. DOI: 10.1007/s00395-012-0294-0. View

20.

Ocwieja M, Meiser K, David O, Valencia J, Wagner F, Schreiber S . Effect of fingolimod (FTY720) on cerebral blood flow, platelet function and macular thickness in healthy volunteers. Br J Clin Pharmacol. 2014; 78(6):1354-65. PMC: 4256624. DOI: 10.1111/bcp.12454. View