Hacettepe University Faculty of Medicine
Department of Neurology

Author Of 1 Presentation

Disease Modifying Therapies – Risk Management Poster Presentation

P0369 - Posibble Risk Factors in Fingolimod Rebound Syndrome (ID 1874)

Presentation Number
Presentation Topic
Disease Modifying Therapies – Risk Management



Fingolimod Rebound Syndrome (FRS) is defined as flare-up of the disease activity upon withdrawal of treatment in patients with MS. FRS is usually seen between the 4th and 16th week following fingolimod discontinuation. In different studies , FRS development rates change between 5% and 52%. It has been reported that, during cessation of fingolimod besides having low lymphocyte count and low EDSS score; response to the treatment (no clinical/radiological activity during the treatment period) and wash out period left after fingolimod could affect FRS development.


The objective of this study was to identify our potential risk factors and the modifable determinants on the development of FRS.


MS patients presenting between 2012 – 2019 and treated with fingolimod were all included in the study. Fingolimod was discontinued after at least 6 months and those experience FRS after cessation were evaluated in terms of all demografic and treatment features.


In totally 661 patients 8.9% (n=59) discontinued fingolimod depending on various reasons. Among the discontinued group 10 (16.9%) patients experienced FRS.

72.9% of the patients were female in the total discontinued group, 60% was female in the FRS group. The median (min-max) MS duration was 10 (2–25) years in the whole group, while it was 9 (4–23) in the FRS group. The median time under fingolimod was 42.5 (16–78) and 43.5 (13–72) months respectively in the discontinued and FRS groups. The washout period after fingolimod was statistically similar between groups (64.5 (7–1270) and 106.5 (7–1110) days respectively (p=0.117)). The mean±SD duration between drug discontinuation and development of FRS was found as 56.98±1.79 days. The median (min-max) of EDSS score of the FRS patients was 4 (1–7) and of the total group it was 4.5 (1–8.5).


Patients should be closely monitored during first two months of cessation of fingolimod therapy and appropriate immunomodulatory treatment should be initiated without delay.