Can Fingolimod Reduce T1 Hypointense and Gadolium Enhancing Lesions in Hispanic MS Patients

Background: The incidence of multiple sclerosis (MS) in Puerto Rico in 2014 was 5.0/100,000.  It is important to study the effectiveness of disease modifying therapy in Hispanic patients with MS. MRI parameters are continually monitored for assessment of treatment efficacy in MS patients.

Objectives: Determine therapeutic effect of Fingolimod (FTY) in a Hispanic population with MS at 1 year by assessing disease burden through serial MRIs.

Methods: 117 Hispanic patients with MS were recruited from a single MS center all diagnosed by a neurologist. Patients had baseline and follow-up imaging at a designated MRI center using a 1.5 T MRI with MS imaging protocol. Three patients had their baseline and follow up MRIs at another MRI center. These 3 images and reports were submitted to the designated MRI center to reduce inter-radiologist bias. All images were interpreted by one neuroradiologist. The neuroradiologist compared baseline and 1 year-follow up images to determine the absence, presence or development of T1 hypointense (BH) and T1 GAD enchancing (GAD) lesion.

Results: 94/117 completed the year. 78% (73) patients were relapsing remitting, 19% (18) were secondary progressive, 2% (2) were clinically isolated syndrome, and 1% (1) was radiologically isolated syndrome. 84% (79) patients had prior use of disease modifying therapies. 19% (18) were men and 81% (76) were women. More than 50% of the population had less than 5 years with the disease. 1/3 of the population was diagnosed between the ages of 30-45 years old. At baseline, there were 50 patients without BH and 44 patients with BH. At 1 year follow up, 88% (44) BH negative patients did not developed BH and 87% (43) of patients with BH at baseline did not develop new BH. 1 patient with BH at baseline did not have BH at 1 year follow up and was deemed transitory BH. At baseline, there were 71 patients without GAD enhancing lesions and 23 patients with GAD enhancing lesions. At 1 year follow up, 95.7% of GAD negative patients did not have GAD enhancement and 87% of patients GAD enhancing lesions at baseline did not develop GAD enhancing lesions. 10 patients were lost to follow up and 13 patients discontinued the medication. Reasons for patient discontinuation: 4 headaches, 4 generalized malaise, 1 lack of efficacy, 2 cost of medication, 1 developed psychotic symptoms, 1 developed macular edema.

Conclusions: FTY is highly efficacious in reducing BH and GAD enhancing lesions. This study can provide clinical insight for the practicing neurologist when treating Hispanic MS patients with aggressive MS. This is an ongoing study.