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Page last updated:29-Aug-2013


An extremely promising therapy which is taken daily by mouth has recently been studied. This drug, fingolimod (also called FTY720) has a uniquely novel mechanism of action. It works on the immune system, but rather than suppressing it or modifying its function, it binds to a receptor on a proportion of circulating lymphocytes and reversibly traps them in lymph nodes. This means a lower number of activated T-cells are available to get into the central nervous system. So inflammation and myelin damage in the brain and spinal cord are reduced. Because the lymphocytes are reversibly trapped in lymph nodes, they are potentially available if needed by the immune system.
Results of the first MS fingolimod studies were presented at the American Academy of Neurology meeting in 2006. Patients taking both low and high dose fingolimod had a more than 50% reduction in their annual relapse rate during the first six months of the study compared to placebo. During a 12 month extension this improvement was maintained. After 18 months, MRI scans showed that most patients were free from lesions which were actively inflamed. Side effects were not serious, comprising mostly mild infections like colds and flu, and headache.

In 2010, large scale studies of fingolimod versus placebo1 and fingolimod versus interferon beta 1a2 were published in the New England Journal of Medicine. In the first study, 1272 people with recent MS relapses were randomised to fingolimod by mouth daily or placebo. The annualised relapse rate for those on fingolimod was roughly half that of those on placebo, with MRI findings similarly better in that group. 1292 people with at least 1 recent relapse were randomised to receive either fingolimod by mouth daily or interferon beta 1a (Avonex) by injection once a week. Relapse rates in the fingolimod group were roughly half that in the interferon group. MRI results were similarly better in the fingolimod group. Two fatal herpes infections occurred in the fingolimod group, in keeping with its immune-suppressant mechanism of action.

There is every reason to be optimistic about this new treatment for MS, for people finding it difficult to control the illness in other ways, although long term side effects of such immune suppression are unknown. An important positive is that the drug is taken orally, so injections are unnecessary.
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  1. Kappos L, Radue EW, O’Connor P, et al. A placebo-controlled trial of oral fingolimod in relapsing multiple sclerosis. N Engl J Med; 362:387-401
  2. Cohen JA, Barkhof F, Comi G, et al. Oral fingolimod or intramuscular interferon for relapsing multiple sclerosis. N Engl J Med; 362:402-415