Opinions

[KatW]

I know, I know, I need to ask my neurologist but I would like to get some of your opinions. I've been on 3 MS meds in the past year. I stopped Copaxone to try Tec. I was allergic to Tec so I switched to Avonex. On Avonex, I've had at least 2 trips a month to the urgent care for various infections. I finally gave up. I couldn't deal with the weekly side effects of Avonex and the monthly illnesses.

I have an appt in 2 weeks. I can go back to Copaxone or try to switch to Gilenya. Do any of you think that I could have the same problems with infections on Gilenya?

[Kimba22]

Do any of you think that I could have the same problems with infections on Gilenya?

Hi KatW,

Sorry to hear of all your problems with previous DMT's. This is definitely a concern to address with your neurologist.

Gilenya™ is a new class of medication called a sphingosine 1-phosphate receptor modulator, which is thought to act by retaining certain white blood cells (lymphocytes) in the lymph nodes, thereby preventing those cells from crossing the blood-brain barrier into the central nervous system (CNS). Preventing the entry of these cells into the CNS reduces inflammatory damage to nerve cells.

http://www.nationalmssociety.org/Tre...ations/Gilenya

It's important to have your wbc counts tested while on this medication, and yours should probably be done more frequently if you do go on Gilenya. While we all react differently, I was one of the few who had some serious infections while on it.

Your neurologist may suggest going back to Copaxone (just wondering why you stopped it? There is a new 3 x a week formulation, if you stopped because of the daily injections) over Gilenya. Another option may be Aubagio.

Best of luck on whichever new DMT you decide, and I hope you'll let us know which one that is.

[KatW]

Thanks, Kimba. I stopped the Copaxone due to a lot of small side effects and the convenience issues. Ultimately, I will have to have a very big discussion with my neurologist.

[Marco]

Gilenya is an immunosuppressant so it's possible you will have MORE infection problems with it. Here is information from the Gilenya prescribing information:


• Infections: GILENYA may increase the risk of infections. A recent CBC should be available before initiating treatment with GILENYA. Monitor for signs and symptoms of infection during treatment and for two months after discontinuation. Do not start GILENYA treatment in patients with active acute or chronic infections.

5.2 Infections
Risk of infections
GILENYA causes a dose-dependent reduction in peripheral lymphocyte count to 20 - 30% of baseline values because of
reversible sequestration of lymphocytes in lymphoid tissues. GILENYA may therefore increase the risk of infections,
some serious in nature [see Clinical Pharmacology (12.2)].
Before initiating treatment with GILENYA, a recent CBC (i.e. within 6 months) should be available. Consider suspending
treatment with GILENYA if a patient develops a serious infection, and reassess the benefits and risks prior to re-initiation of therapy. Because the elimination of fingolimod after discontinuation may take up to two months, continue monitoring for infections throughout this period. Instruct patients receiving GILENYA to report symptoms of infections to a physician. Patients with active acute or chronic infections should not start treatment until the infection(s) is resolved.

Two patients died of herpetic infections during GILENYA controlled studies in the premarketing database (one
disseminated primary herpes zoster and one herpes simplex encephalitis). In both cases, the patients were receiving a
fingolimod dose (1.25 mg) higher than recommended for the treatment of MS (0.5 mg), and had received high dose
corticosteroid therapy for suspected MS relapse. No deaths due to viral infections occurred in patients treated with
GILENYA 0.5 mg in the premarketing database.
In MS controlled studies, the overall rate of infections (72%) and serious infections (2%) with GILENYA 0.5 mg was
similar to placebo. However, bronchitis and, to a lesser extent, pneumonia were more common in GILENYA-treated
patients. Concomitant use with antineoplastic, immunosuppressive or immune modulating therapies
GILENYA has not been administered concomitantly with antineoplastic, immunosuppressive or immune modulating
therapies used for treatment of MS. Concomitant use of GILENYA with any of these therapies would be expected to
increase the risk of immunosuppression [see Drug Interactions (7)]. Varicella zoster virus antibody testing/vaccination As for any immune modulating drug, before initiating GILENYA therapy, patients without a history of chickenpox or without vaccination against varicella zoster virus (VZV) should be tested for antibodies to VZV. VZV vaccination of antibody-negative patients should be considered prior to commencing treatment with GILENYA, following which initiation of treatment with GILENYA should be postponed for 1 month to allow the full effect of vaccination to occur.