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MS – Fingolimod Complications — SCE Neurology MCQ

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ModerateMultiple Sclerosis & CNS InflammationMS – Fingolimod ComplicationsSCE Neurology

A 42-year-old woman with RRMS has been stable on fingolimod for 4 years. She is found to have a lymphocyte count of 0.15 × 10⁹/L on routine bloods. She is asymptomatic. What is the most appropriate action?

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Correct answer: B — Suspend fingolimod until lymphocyte count recovers to >0.2 × 10⁹/L

Fingolimod causes dose-dependent lymphopenia by sequestering lymphocytes in lymph nodes. The SmPC advises that if confirmed lymphocyte count falls below 0.2 × 10⁹/L, fingolimod should be suspended until recovery. The drug should be withheld if lymphocytes remain critically low as this increases infection risk, including PML. A: Continuing with such a low count is unsafe. B: Fingolimod is not available in dose-reducible formulations for MS. D: Abrupt switching without managing the current lymphopenia is premature. E: Aciclovir prophylaxis alone does not address the risk.

Reference: Fingolimod SmPC; NICE TA254 Fingolimod (2012)