Lymphocyte sub-populations and their adverse effects in patients with relapsing-remitting multiple sclerosis treated with Fingolimod: experience in our hospital

Abstract

INTRODUCTION: The fingolimod, second line treatment for remittent recurrent Multiple Sclerosis (RRMS) modulates the sphingosine-1-phosphate (S1P) receptor preventing the exit of lymphocytes from lymph nodes; reporting secondary lymphopenia and infections by opportunistic microorganisms. Lymphopenia affects more cells CD4 + CD8 +, decrease ratio CD4 + / CD8 + (2), owing to cellular redistribution. The rate of effectors memory cells is not affected.

OBJECTIVE: To observe the lymphocyte subpopulations and the presence of adverse effects in RRMS patients treated with fingolimod in our hospital.

METHODS: 23 included patients with RRMS in therapy fingolimod, 22 women and 1 man, with an average age of 41.75 ±10. 78, average diagnosis time in months of 75.8 ±51.8, and mean follow-up time in months of 22.36 ±11 manual angle adjustment. 25. Lymphocyte subpopulations were measured at the start and then every 3 months. Results reported in mean ± standard deviation.

RESULTS: There were the following quantification: CD4 727.41 ±407. 1, 366.58 CD8 ±119. 62, 1.88 CD4/CD8 ratio ±0. 7 at the beginning of the treatment; CD4 190.25 ±238. 5, 200 CD8 ±152. 4, CD4/CD8 0.9 relationship ±0. 7 to 3 months; CD4 65 ±27. 6, CD8 88 ±28. 17, 0.8 CD4/CD8 ratio ±0. 4 to 6 months; CD4 45 ±26, CD8 172,5 ±90. 5, relationship CD4/CD8 0.5 ±0. 4 to 9 months; CD4 2225 ±5. 26, CD8 148.75 ±71. 23, relationship CD4/CD8 0.25 ±0. 2 at 12 months; CD4 31.33 ±13. 47, CD8 79 ±24. 26, CD4/CD8 0.4 relationship ±0. 08 to 15 months; CD4 17.5 ±2. 5, 142.5 CD8 ±115. 5, CD4/CD8 0.4 relationship ±0. 3 to 18 months; CD4 36.5 ±4. 5, CD8 123 ±26, relationship CD4/CD8 0.3 ±0. 1 to 21 months.

CONCLUSIONS: There is a decline in subpopulations of CD4 + and CD8 + in patients treated with fingolimod, most evident in the CD4 +. Despite this infections were not presented by opportunistic microorganisms.