Multiple sclerosis relapse after discontinuation of oral disease modifying therapies: Comparison of fingolimod and dimethyl fumarate

Abstract

Abstract Background: The discontinuation of oral disease modifying therapies before pregnancy, especially in the patients receiving fingolimod, may lead to disease relapse and progression. The intent of this study is to compare the number of attacks and EDSS scores after fingolimod and dimethyl fumarate cessation due to pregnancy. Methods: This is a cross-sectional study on pregnant women with multiple sclerosis (MS) who were on fingolimod or dimethyl fumarate and discontinued the drugs before their pregnancy. Evaluation was done by a checklist and patients’ file. Disease attacks and expanded disability status scale (EDSS) scores before, during, and after pregnancy were evaluated. Results: In our study, 13 people with MS (pwMS) using fingolimod and 16 pwMS using dimethyl fumarate discontinued their medication due to pregnancy. In the fingolimod and dimethyl fumarate groups, the median (range) number of attacks after drug withdrawal was 3 (0-4) and 0 (0-2), respectively. The median (range) six month post-delivery EDSS scores was 3.00 (1-8) in the fingolimod group and 1.5 (1-4) in the dimethyl fumarate group. Attacks were see 4.92 times more often after fingolimod cessation as compared to dimethyl fumarate discontinuation. Conclusion: Fingolimod discontinuation due to pregnancy was linked to higher rates of attacks as compared to dimethyl fumarate cessation.