Fingolimod in relapsing multiple sclerosis: An integrated analysis of safety findings

Abstract Background Fingolimod 0.5mg once daily is the first approved oral therapy for relapsing multiple sclerosis (MS). Objective To report integrated long-term safety data from phase 2/3 fingolimod studies. Methods Descriptive safety data are reported from the FTY720 Research Evaluating Effects of Daily Oral Therapy in Multiple Sclerosis (FREEDOMS) study, a 24-month, randomized, double-blind study comparing fingolimod 0.5mg and 1.25mg with placebo, and an All Studies group (patients who received fingolimod 0.5mg ( n =1640) or 1.25–0.5mg ( n =1776) in phase 2/3 studies and associated extensions). Relevant post-marketing experience, up to December 2011, is included. Results The incidence of adverse events (AEs) and serious AEs (SAEs) was similar with fingolimod and placebo in FREEDOMS. In the All Studies group, fingolimod 0.5mg was associated with transient, rarely symptomatic (0.5%), bradycardia and second-degree atrioventricular block on treatment initiation, minor blood pressure increases, frequent (9%) but generally asymptomatic liver enzyme elevations, and macular oedema (0.4%). The incidences of infections (including serious and herpes infections), malignancies, SAEs and treatment discontinuations due to AEs were similar with fingolimod 0.5mg and placebo. Conclusion The safety profile of fingolimod has been well characterized in this large combined trial population. Although infrequent SAEs can occur, there is no increased risk of infections, malignancies or serious cardiovascular events versus placebo.