Atrioventricular block after fingolimod resumption: a consequence of sphingosine-1-phosphate axis alteration due to COVID-19?

Abstract

During the COVID-19 pandemic, concerns raised regarding the use of immunosuppressants in multiple sclerosis, even if current data do not support an increased risk of infection. Although fingolimod can be temporarily suspended during COVID-19, the benefit-risk balance of suspension can be challenging. Till now, no adverse events have been described after the resumption of fingolimod, following a previous discontinuation. We report the occurrence of atrioventricular block following fingolimod restart. Fingolimod acts on sphingosine-1-phosphate-axis, a pathway that is altered with COVID-19 and hypoxic conditions. Herein we discuss how these metabolic changes may have influenced fingolimod pharmacology leading to a cardiac event.

• Authors: Mario Orrico, Agostino Nozzolillo, Stefano Gelibter, Francesca Sangalli, Paolo Preziosa, Massimo Filippi, Lucia Moiola
• Journal: Journal of neurology (J Neurol) Vol. 268 Issue 11 Pg. 3975-3979 (Nov 2021) ISSN: 1432-1459 [Electronic] Germany
• PMID: 33852086 (Publication Type: Journal Article)
• Copyright: © 2021. Springer-Verlag GmbH Germany, part of Springer Nature.

Chemical References

• Lysophospholipids
• sphingosine 1-phosphate
• Fingolimod Hydrochloride
• Sphingosine

Topics

• Atrioventricular Block (chemically induced)
• COVID-19
• Fingolimod Hydrochloride (adverse effects)
• Humans
• Lysophospholipids
• Pandemics
• SARS-CoV-2
• Sphingosine (analogs & derivatives)