Fingolimod Titration Is an Option to Manage Side Effects Effectively, Reduce Patient Treatment Withdrawal and Achieve a Full Therapeutic Dose Regime

Background:  Fingolimod is reported to have an acceptable safety profile however unwanted side effects result in a portion of patients withdrawing from treatment. A major teaching hospital which is supported by MS Nursing expertise experimented with side effect management and titrating dose strategies. This personalised approach resulted in the majority of patients remaining on treatment and tolerating the full recommended therapeutic dose. 

 Objectives: To reduce and eliminate treatment side effects, reduce patient treatment withdrawal, and achieve the full therapeutic dose regime.

Methods: In collaboration with the neurologist, MS Nurses were engaged to manage side effects, and titrate the Fingolimod dose as required. Patients who chose to withdraw from Fingolimod were given the option of a personalised management plan. The program offered regular monitoring, side effect management, and Fingolimod dose adjustments as required. Ongoing consultation with the neurologist by the nursing staff was maintained, and supportive medication prescribed as needed. Services were delivered via phone consultation, email, fax, mail, clinic visits and the patient’s general physician.

Results: In total 209 patients were treated with Fingolimod. Clinically significant adverse events such as Lymphopenia, Herpes Zoster, Malignancy, Headache,  Ophthalmic symptoms,  Gastrointestinal disturbance  and a general feeling of being unwell were reported by n=51 (24.4%).From this group of patients n=24( 47%) were offered a side effect management and drug titration plan, n=16 (66.7%) agreed to participate in the treatment approach. Patients diagnosed with Malignancy, Ophthalmic symptoms and opportunistic infections were excluded from the invitation. By providing an option to this selected patient group, and adopting a go slow approach, n=10 ((62.5%) were able to reach the full recommended therapeutic dose and remain on treatment, n=2 (12.5%) patients discontinued treatment due to poor tolerance and n=4 (25%) continue to remain on drug titration.

Conclusions: An individualised side effect management and titration dose plan, which is supported by MS nursing expertise can reduce patient treatment withdrawal and substantially increase full dose medication tolerance.