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We report on a woman who developed critical arterial vasospasm of the left arm within 7 days after having started treatment with Fingolimod (FTY720). Fingolimod is an orally administered modulator of the sphingosine-1-phosphate (S1P) receptor family, acting at 4 of the 5 G protein-coupled S1P receptors. It causes a reversible sequestration of lymphocytes into lymph nodes, thereby inhibiting their migration to sites of inflammation. Fingolimod is currently tested in clinical trials for the treatment of relapsing-remitting multiple sclerosis (RRMS). As S1P receptors regulate numerous cellular processes in different tissues, Fingolimod exhibits the capacity to induce versatile pharmacologic effects.
Classification of evidence.
This is a single observational study without controls; therefore, level of evidence is IV.
Case report.
A 41-year-old woman was recruited in February 2007 as a participant of the TRANSFORMS study,1 a clinical phase III trial comparing the efficacy and safety of oral Fingolimod at 0.5 mg or 1.25 mg per day vs IM interferon β-1a in patients with RRMS (extension phase will continue with 0.5 mg only). The patient had been diagnosed with RRMS according to McDonald criteria 4 years earlier. She had never received any immunomodulatory drugs and had no relevant medical history. She was taking carbamazepine for paroxysmal brainstem symptoms.
After 7 days of treatment with the study medication, she noticed intermittent pain in the fingertips of her left hand. The physical examination was normal and a Raynaud phenomenon was suspected. …
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