Efficacy of Fingolimod in Ethnic Minorities

Background: Multiple Sclerosis is an autoimmune, demyelinating and degenerative disease of the central nervous system.  It primarily affects Caucasians, but is also observed in African Americans, Afro-Carribeans, Asians, and Hispanics.  There is a growing body of literature describing the clinical differences or similarities of MS among different ethnicities.  However, there is very little literature to date regarding the efficacy of the currently available disease modifying therapies in minority populations.  There is some literature to suggest that African Americans may respond differently to interferon therapy.   There has been one retrospective chart review evaluating the efficacy of the injectable therapies in patients with multiple sclerosis in Argentina.  There is no literature published to date regarding the efficacy of the first oral agent for MS, fingolimod, in ethnic minorities. 

Objectives: To evaluate the efficacy of fingolimod in ethnic minorities. 

Methods: Retrospective chart review of ethnic minorities started on fingolimod in our clinic.   The charts of all patients started on fingolimod from September 2010 to August 2012 were review.  Those patients identified as African American, Hispanic, Arabic/Middle Eastern, or Asian were included in our analysis.  Charts were reviewed for number of relapses in the 2 years prior to starting on fingolimod therapy, number of relapses after starting on fingolimod therapy, MRI changes on fingolimod therapy, and prior DMT. 

Results: All patients that had been started on fingolimod from September 2010 to August 2012 were identified and charts reviewed.  A total of 22 patients were identified as African American, Hispanic, Arabic/Middle Eastern, or Asian.  Of these 13 are African American, 6 Hispanic and 3 Arabic/Middle Eastern.  The annualized relapse rate in the 2 years prior to starting fingolimod was 0.66.  After starting fingolimod ARR decreased by 75% to 0.16.  Average duration of fingolimod treatment was 15 months.  One patient stopped fingolimod therapy due to clinical relapse and MRI progression.  One patient stopped because she suffered a myocardial infarction while on therapy. 

Conclusions: Fingolimod appears to be an effective therapy for reduction of relapses in ethnic minorities with relpasing remitting multiple sclerosis.