Immune thrombocytopenic purpura associated with fingolimod

BMJ Case Rep. 2017 Sep 11:2017:bcr2017220590. doi: 10.1136/bcr-2017-220590.

Abstract

Fingolimod is an oral sphingosine-1-phosphate receptor modulator which causes lymphocyte sequestration in lymph nodes and is approved for relapsing multiple sclerosis. The Therapeutic Goods Administration of Australia is aware of only one case where fingolimod preceded immune thrombocytopenic purpura (ITP) by 5 weeks. Here we report three such cases.None were on any medications known to cause ITP and routine investigations were unremarkable. All cases were treated with immunosuppression. Case 1 successfully weaned prednisolone after fingolimod cessation whereas case 2 weaned slowly while continuing fingolimod therapy. Case 3 had more refractory ITP and re-exposure to fingolimod worsened thrombocytopenia.There was a temporal association between fingolimod exposure and ITP however dose-effect association and pathogenesis remain less clear.In conclusion, our cases highlight that clinicians should be aware of the possible association between ITP and fingolimod.

Keywords: Drugs And Medicines; Haematology (incl Blood Transfusion); Neurology (drugs And Medicines).

Publication types

  • Case Reports

MeSH terms

  • Blood Platelets / drug effects*
  • Disease Management
  • Female
  • Fingolimod Hydrochloride / administration & dosage
  • Fingolimod Hydrochloride / adverse effects*
  • Fingolimod Hydrochloride / therapeutic use
  • Glucocorticoids / therapeutic use
  • Humans
  • Immunologic Factors / therapeutic use
  • Immunosuppressive Agents / administration & dosage
  • Immunosuppressive Agents / adverse effects*
  • Middle Aged
  • Multiple Sclerosis / complications
  • Multiple Sclerosis / drug therapy*
  • Natalizumab / therapeutic use
  • Prednisolone / administration & dosage
  • Prednisolone / therapeutic use
  • Purpura, Thrombocytopenic, Idiopathic / chemically induced*
  • Purpura, Thrombocytopenic, Idiopathic / drug therapy
  • Receptors, Fc / therapeutic use
  • Receptors, Lysosphingolipid / agonists
  • Recombinant Fusion Proteins / therapeutic use
  • Thrombopoietin / therapeutic use
  • Treatment Outcome
  • Young Adult

Substances

  • Glucocorticoids
  • Immunologic Factors
  • Immunosuppressive Agents
  • Natalizumab
  • Receptors, Fc
  • Receptors, Lysosphingolipid
  • Recombinant Fusion Proteins
  • Thrombopoietin
  • Prednisolone
  • Fingolimod Hydrochloride
  • romiplostim