Contributions
Abstract: EP1511
Type: ePoster
Abstract Category: Therapy - disease modifying - Long-term treatment monitoring
Background: Fingolimod (FTY720, Gilenya ) is an oral disease modifying therapy approved for highly active relapsing remitting multiple sclerosis. It prevents transfer of autoreactive lymphocytes across the blood-brain barrier by modulating the sphingosine 1-phosphate receptor (S1PR). Fingolimod also binds to atrial myocyte S1PRs leading to potassium influx, decreased firing and bradycardia or conduction abnormalities within 6 hours of the first dose. Cardiac screening during first dose administration is therefore standard practice.
Objectives: To determine the value of further cardiac monitoring performed periodically beyond first dose in patients on Fingolimod to identify possible delayed adverse effects on atrioventricular conduction.
Method: Audit of results of 3-monthly Holter-ECG monitoring over 12 months in patients receiving Fingolimod for relapsing remitting MS across Greater Manchester, UK.
Results: All patients (n=40) had pre-treatment cardiac screening and were monitored for 6 hours after first dose. Extended monitoring beyond 6 hours was required in 6 cases. Non-significant supraventricular and ventricular ectopics were the most commonly detected anomalies. One patient with pre-existing first degree heart block received Fingolimod without complications. We encountered one case of Mobitz Type II heart block and complete heart block during first dose monitoring that led to drug discontinuation. Importantly, no clinically relevant arrhythmias were identified in any of our patients on serial 3-monthly five day Novacor arrhythmia recordings over the first 12 months of treatment.
Conclusion: Regular 3-monthly cardiac monitoring beyond first dose in our cohort of patients on Fingolimod identified no serious cardiac arrythmias and appears unnecessary. Clinicians should however remain vigilant to patient-reported symptoms that may suggest problems with atrioventricular conduction.
Disclosure:
Liezel Griffin: nothing to disclose
Peter Woolfson: nothing to disclose
Daniel Dunbar: nothing to disclose
Fran Jackson: nothing to disclose
David Rog: nothing to disclose
Paul Talbot: nothing to disclose
Nazar Sharaf: nothing to disclose
Tatiana MIhalova: nothing to disclose
Adrian Pace: nothing to disclose
Abstract: EP1511
Type: ePoster
Abstract Category: Therapy - disease modifying - Long-term treatment monitoring
Background: Fingolimod (FTY720, Gilenya ) is an oral disease modifying therapy approved for highly active relapsing remitting multiple sclerosis. It prevents transfer of autoreactive lymphocytes across the blood-brain barrier by modulating the sphingosine 1-phosphate receptor (S1PR). Fingolimod also binds to atrial myocyte S1PRs leading to potassium influx, decreased firing and bradycardia or conduction abnormalities within 6 hours of the first dose. Cardiac screening during first dose administration is therefore standard practice.
Objectives: To determine the value of further cardiac monitoring performed periodically beyond first dose in patients on Fingolimod to identify possible delayed adverse effects on atrioventricular conduction.
Method: Audit of results of 3-monthly Holter-ECG monitoring over 12 months in patients receiving Fingolimod for relapsing remitting MS across Greater Manchester, UK.
Results: All patients (n=40) had pre-treatment cardiac screening and were monitored for 6 hours after first dose. Extended monitoring beyond 6 hours was required in 6 cases. Non-significant supraventricular and ventricular ectopics were the most commonly detected anomalies. One patient with pre-existing first degree heart block received Fingolimod without complications. We encountered one case of Mobitz Type II heart block and complete heart block during first dose monitoring that led to drug discontinuation. Importantly, no clinically relevant arrhythmias were identified in any of our patients on serial 3-monthly five day Novacor arrhythmia recordings over the first 12 months of treatment.
Conclusion: Regular 3-monthly cardiac monitoring beyond first dose in our cohort of patients on Fingolimod identified no serious cardiac arrythmias and appears unnecessary. Clinicians should however remain vigilant to patient-reported symptoms that may suggest problems with atrioventricular conduction.
Disclosure:
Liezel Griffin: nothing to disclose
Peter Woolfson: nothing to disclose
Daniel Dunbar: nothing to disclose
Fran Jackson: nothing to disclose
David Rog: nothing to disclose
Paul Talbot: nothing to disclose
Nazar Sharaf: nothing to disclose
Tatiana MIhalova: nothing to disclose
Adrian Pace: nothing to disclose