First experiences with fingolimod in two female adolescents with relapsing multiple sclerosis

Introduction: Fingolimod is a new drug, orally administered, for the treatment of relapsing multiple sclerosis (MS). The application is off label for children or adolescents under the age of 18. Till today there are no reports about the application in adolescents.

Case Report: We report two female adolescents, 15 and 17 years old, with relapsing MS, who were under an immunomodulating therapy with interferon for nearly 2 years with side effects and several relapses during this period, so we decided for an escalating therapy. Natalizumab is the drug of choice in this situation, but the use is off label under the age of 18 and the drug must be administered by an infusion every month and there are possible severe side effects such as progressive multifocal leukoencephalopathy. Fingolimod was licensed in Switzerland in 2011 and both girls decided for this drug. So we started with this therapy in November 2011 for one girl and in May 2012 for the other girl with all necessary precautions. Till today both girls show only the well-known side effect of lymphopenia, but no infections and no relapses of the MS.

Conclusion: Fingolimod can be an alternative therapy in relapsing MS also in adolescents instead of natalizumab and has the advantage of oral application. But further clinical trials are necessary.