tetano
Editor, Senior Moderator
Mult Scler Relat Disord. 2020 May 6;42:102180. doi: 10.1016/j.msard.2020.102180. [Epub ahead of print]
Severe COVID-19 infection in a patient with multiple sclerosis treated with fingolimod.
Foerch C[SUP]1[/SUP], Friedauer L[SUP]2[/SUP], Bauer B[SUP]3[/SUP], Wolf T[SUP]4[/SUP], Adam EH[SUP]5[/SUP].
Author information
Abstract
BACKGROUND:
Fingolimod is used for immune therapy in patients with multiple sclerosis. Long-term treatment is associated with a small increase in the risk of herpes virus reactivation and respiratory tract infections. Patients with coronavirus disease 2019 (COVID-19) under Fingolimod treatment have not been described.
METHODS AND RESULTS:
We report a 57-year old female patient with a relapsing remitting multiple sclerosis under fingolimod treatment who experienced a severe COVID-19 infection in March 2020 (Extended Disability Status Scale: 2.0). Having peripheral lymphopenia typical for fingolimod treatment (total lymphocytes 0.39/nL [reference range 1.22-3.56]), the patient developed bilateral interstitial pneumonia with multiple ground-glass opacities on chest CT. Fingolimod medication was stopped. On the intensive care unit, non-invasive ventilation was used to provide oxygen and ventilation support regularly. Over the following two days, oxygenation improved, and the patient was transferred to a normal ward five days after admission.
CONCLUSION:
The implications fingolimod has on COVID-19 are complex. As an S1P analogue, fingolimod might enhance lung endothelial cell integrity. In addition, in case of a so-called cytokine storm, immunomodulation might be beneficial to reduce mortality. Future studies are needed to explore the risks and therapeutic effects of fingolimod in COVID-19 patients.
Copyright ? 2020 The Author(s). Published by Elsevier B.V. All rights reserved.
KEYWORDS:
COVID-19; Critical care; Fingolimod; Multiple sclerosis; Viral infection
PMID:32408155DOI:10.1016/j.msard.2020.102180
Severe COVID-19 infection in a patient with multiple sclerosis treated with fingolimod.
Foerch C[SUP]1[/SUP], Friedauer L[SUP]2[/SUP], Bauer B[SUP]3[/SUP], Wolf T[SUP]4[/SUP], Adam EH[SUP]5[/SUP].
Author information
Abstract
BACKGROUND:
Fingolimod is used for immune therapy in patients with multiple sclerosis. Long-term treatment is associated with a small increase in the risk of herpes virus reactivation and respiratory tract infections. Patients with coronavirus disease 2019 (COVID-19) under Fingolimod treatment have not been described.
METHODS AND RESULTS:
We report a 57-year old female patient with a relapsing remitting multiple sclerosis under fingolimod treatment who experienced a severe COVID-19 infection in March 2020 (Extended Disability Status Scale: 2.0). Having peripheral lymphopenia typical for fingolimod treatment (total lymphocytes 0.39/nL [reference range 1.22-3.56]), the patient developed bilateral interstitial pneumonia with multiple ground-glass opacities on chest CT. Fingolimod medication was stopped. On the intensive care unit, non-invasive ventilation was used to provide oxygen and ventilation support regularly. Over the following two days, oxygenation improved, and the patient was transferred to a normal ward five days after admission.
CONCLUSION:
The implications fingolimod has on COVID-19 are complex. As an S1P analogue, fingolimod might enhance lung endothelial cell integrity. In addition, in case of a so-called cytokine storm, immunomodulation might be beneficial to reduce mortality. Future studies are needed to explore the risks and therapeutic effects of fingolimod in COVID-19 patients.
Copyright ? 2020 The Author(s). Published by Elsevier B.V. All rights reserved.
KEYWORDS:
COVID-19; Critical care; Fingolimod; Multiple sclerosis; Viral infection
PMID:32408155DOI:10.1016/j.msard.2020.102180