Fingolimod treatment in multiple sclerosis

Objective: To determine whether fingolimod, an oral sphingosine-1-phosphate receptor modulator approved for treatment of multiple sclerosis (MS), generally leads to increased retinal tissue volume. Methods: In this longitudinal observational study, we compared changes in macular volume on spectral-domain optical coherence tomography (OCT) between consecutive patients with MS who initiated fingolimod and a matched reference cohort of patients with MS never exposed to the drug. The primary reference cohort was matched based on time interval between OCT examinations. A secondary reference cohort was matched based on age and disease duration. Change in macular volume within each group was analyzed using the paired t test. Change in macular volume between groups was examined using multiple linear regression. Results: Macular volume increased by a mean of 0.025 mm3 (95% confidence interval [CI] 10.017 to 10.033, p , 0.001) in the 30 patients with MS who initiated fingolimod over a mean follow-up time of 5 months (SD 3). Macular volume did not significantly change over a mean follow-up time of 6 months (SD 4) in a comparison group of 30 patients with MS never treated with fingolimod (mean change of 20.003 mm3, 95% CI 20.009 to 10.004, p 5 0.47). Overall, 74% of eyes in the fingolimod-treated group exhibited an increase in macular volume vs 37% of eyes in the comparison group. Conclusion: Initiation of fingolimod in MS is associated with a modest, relatively rapid increase in macular volume. Neurology! 2013;80:139–144