Extensive Multiple Sclerosis Reactivation after Switching from Fingolimod to Rituximab
During treatment with fingolimod, B cells are redistributed from blood to secondary lymphoid organs, where they are protected from the effect of anti-CD20 and other cell-depleting therapies. We describe a multiple sclerosis patient who had almost complete depletion of B cells in blood during and sho...
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Series: | Case Reports in Neurological Medicine |
Online Access: | http://dx.doi.org/10.1155/2018/5190794 |
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doaj-d9250688ec944657b0cc9443a4e50f1c2020-11-24T20:42:53ZengHindawi LimitedCase Reports in Neurological Medicine2090-66682090-66762018-01-01201810.1155/2018/51907945190794Extensive Multiple Sclerosis Reactivation after Switching from Fingolimod to RituximabTrygve Holmøy0Øivind Torkildsen1Svetozar Zarnovicky2Department of Neurology, Akershus University Hospital, Lørenskog, NorwayDepartment of Neurology, Haukeland University Hospital, Bergen, NorwayDepartment of Radiology, Akershus University Hospital, Lørenskog, NorwayDuring treatment with fingolimod, B cells are redistributed from blood to secondary lymphoid organs, where they are protected from the effect of anti-CD20 and other cell-depleting therapies. We describe a multiple sclerosis patient who had almost complete depletion of B cells in blood during and shortly after treatment with fingolimod. He developed severe disease activity resembling immune reconstitution syndrome after switching from fingolimod to rituximab, with first dose being six weeks after fingolimod cessation. Following recommendations from the Swedish MS Association, rituximab treatment was started as one single dose of 1000 mg. In patients treated with fingolimod, pathogenic B cells may still be sequestered in secondary lymph nodes if this dose is given early. To deplete such B cells as they egress from the lymph nodes, we propose that a second dose of rituximab a few weeks after the first dose should be considered.http://dx.doi.org/10.1155/2018/5190794 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Trygve Holmøy Øivind Torkildsen Svetozar Zarnovicky |
spellingShingle |
Trygve Holmøy Øivind Torkildsen Svetozar Zarnovicky Extensive Multiple Sclerosis Reactivation after Switching from Fingolimod to Rituximab Case Reports in Neurological Medicine |
author_facet |
Trygve Holmøy Øivind Torkildsen Svetozar Zarnovicky |
author_sort |
Trygve Holmøy |
title |
Extensive Multiple Sclerosis Reactivation after Switching from Fingolimod to Rituximab |
title_short |
Extensive Multiple Sclerosis Reactivation after Switching from Fingolimod to Rituximab |
title_full |
Extensive Multiple Sclerosis Reactivation after Switching from Fingolimod to Rituximab |
title_fullStr |
Extensive Multiple Sclerosis Reactivation after Switching from Fingolimod to Rituximab |
title_full_unstemmed |
Extensive Multiple Sclerosis Reactivation after Switching from Fingolimod to Rituximab |
title_sort |
extensive multiple sclerosis reactivation after switching from fingolimod to rituximab |
publisher |
Hindawi Limited |
series |
Case Reports in Neurological Medicine |
issn |
2090-6668 2090-6676 |
publishDate |
2018-01-01 |
description |
During treatment with fingolimod, B cells are redistributed from blood to secondary lymphoid organs, where they are protected from the effect of anti-CD20 and other cell-depleting therapies. We describe a multiple sclerosis patient who had almost complete depletion of B cells in blood during and shortly after treatment with fingolimod. He developed severe disease activity resembling immune reconstitution syndrome after switching from fingolimod to rituximab, with first dose being six weeks after fingolimod cessation. Following recommendations from the Swedish MS Association, rituximab treatment was started as one single dose of 1000 mg. In patients treated with fingolimod, pathogenic B cells may still be sequestered in secondary lymph nodes if this dose is given early. To deplete such B cells as they egress from the lymph nodes, we propose that a second dose of rituximab a few weeks after the first dose should be considered. |
url |
http://dx.doi.org/10.1155/2018/5190794 |
work_keys_str_mv |
AT trygveholmøy extensivemultiplesclerosisreactivationafterswitchingfromfingolimodtorituximab AT øivindtorkildsen extensivemultiplesclerosisreactivationafterswitchingfromfingolimodtorituximab AT svetozarzarnovicky extensivemultiplesclerosisreactivationafterswitchingfromfingolimodtorituximab |
_version_ |
1716821434325532673 |