You asked about switching from fingolimod to another imod or anti-CD20. I am sorry I can’t give advice and maybe profK can tell us about the BartsMS standard, but it is important that the switch occurs to stop rebound occurring. Some people repopulate slowly after fingolimod but here is one persons view. It is open access so you can have a read.
Because the treatment of multiple sclerosis (MS) may span decades, the need often arises to make changes to the treatment plan in order to accommodate changing circumstances. Switching drugs, or the discontinuation of immunomodulatory agents altogether, may leave patients vulnerable to relapse or disease progression. In some cases, severe MS disease activity is noted clinically and on MRI after treatment withdrawal. When this disease activity is disproportionate to the pattern observed prior to treatment initiation, patients are said to have experienced rebound. Of the US Food and Drug Administration (FDA)-approved agents to treat MS, the drugs most commonly implicated in rebound are natalizumab and fingolimod. In this review based on the reported cases and data from clinical trials, we characterize disease rebound after fingolimod cessation. We also outline fingolimod rebound management considerations, summarizing what evidence is available to help clinicians mitigate the risk of rebound, switch therapies, and treat rebound events when they occur. The commonly encountered situation of fingolimod discontinuation prior to pregnancy is also discussed.
Malpas CB, Roos I, Sharmin S, Buzzard K, Skibina O, Butzkueven H, Kappos L, Patti F, Alroughani R, Horakova D, Havrdova EK, Izquierdo G, Eichau S, Hodgkinson S, Grammond P, Lechner-Scott J, Kalincik T; MSBase Study Group. Multiple Sclerosis Relapses Following Cessation of Fingolimod. Clin Drug Investig. 2022 Apr;42(4):355-364.
Background: There is growing interest in the issue of disease reactivation in multiple sclerosis following fingolimod cessation. Relatively little is known about modifiers of the risk of post-cessation relapse, including the delay to commencement of new therapy and prior disease activity.
Objective: We aimed to determine the rate of relapse following cessation of fingolimod and to identify predictors of relapse following cessation.
Methods: Data were extracted from the MSBase registry in March 2019. Inclusion criteria were (a) clinically definite relapsing multiple sclerosis, (b) treatment with fingolimod for ≥ 12 months, (c) follow-up after cessation for ≥ 12 months, and (d) at least one Expanded Disability Status Scale score recorded in the 12 months before cessation.
Results: A total of 685 patients were identified who met criteria. The mean annualised relapse rate was 1.71 (95% CI 1.59, 1.85) in the year prior to fingolimod, 0.50 (95% CI 0.44, 0.55) on fingolimod and 0.43 (95% CI 0.38, 0.49) after fingolimod. Of these, 218 (32%) patients experienced a relapse in the first 12 months. Predictors of a higher relapse rate in the first year were: younger age at fingolimod cessation, higher relapse rate in the year prior to cessation, delaying commencement of new therapy and switching to low-efficacy therapy.
Conclusions: Disease reactivation following fingolimod cessation is more common in younger patients, those with greater disease activity prior to cessation and in those who switch to a low-efficacy therapy.
COI: None relevant
Disclaimer there are the views of te author and no one else