Severe COVID-19 infection in a patient with multiple sclerosis treated with fingolimod

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. Pa
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.
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Metadaten
Author:Christian Förch, Lucie Friedauer, Boris Bauer, Timo Wolf, Elisabeth H. Adam
URN:urn:nbn:de:hebis:30:3-547357
DOI:http://dx.doi.org/10.1016/j.msard.2020.102180
ISSN:2211-0348
Parent Title (English):Multiple sclerosis and related disorders
Publisher:Elsevier
Place of publication:Amsterdam [u.a.]
Document Type:Article
Language:English
Date of Publication (online):2020/05/06
Date of first Publication:2020/05/06
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2020/07/06
Tag:COVID-19; Critical care; Fingolimod; Multiple sclerosis; Viral infection
Volume:42
Issue:102180
Pagenumber:3
HeBIS PPN:467705356
Institutes:Medizin
Dewey Decimal Classification:610 Medizin und Gesundheit
Sammlungen:Universitätspublikationen
Licence (German):License LogoCreative Commons - Namensnennung-Nicht kommerziell - Keine Bearbeitung 4.0

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