MS- Fingolimod DI

Question 1

Fingolimod brand name

Answer 1

Gilenya

Question 2

Fingolimod indications

Answer 2

CIS, RRMS, active SPMS

Question 3

Fingolimod MoA

Answer 3

Acts on S1P1 and S1P3-5 on lymphocyte surfaces to deplete CD4+ and CD8+ T-lymphocytes in the bloodstream and inhibits lymphocyte release from the lymph nodes

Question 4

Fingolimod dosing

Answer 4

0.5mg PO QD

Question 5

Fingolimod ADEs (not dose-dependent)

Answer 5

Heart rate decrease on day 1, but attenuates over time
Mild-moderate decrease in FEV1 at high doses

Headache, lymphopenia, leukopenia, URTIs, cough, sinusitis, nasopharyngitis, changes in FEV1, influenza, elevation in LFTs, abdominal pain, back pain, pain in extremities, diarrhea

PML has been reported

Question 6

Dose-dependent ADEs of fingolimod

Answer 6

transient heart rate reduction on treatment initiation, small increase in BP, liver enzyme elevations, macular edema

Question 7

Patients without VZV antibodies but want to take fingolimod

Answer 7

Get the vaccine 30 days before starting treatment

Question 8

Fingolimod DDIs

Answer 8

Metabolized by 4F2, no DDIs and no toxic metabolites

Question 9

Fingolimod monitoring

Answer 9

FIRST DOSE MONITORING, macular exams

Question 10

Fingolimod first-dose monitoring

Answer 10

Get ECG before starting

Monitor HR and BP hourly for 6 hours after the first dose for bradycardia

Question 11

Fingolimod half-life

Answer 11

6-9 days