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Khan AA, Gutlapalli SD, Sohail M, Patel P, Midha S, Shukla S, Dhamija D, Bello AO, Elshaikh AO. Fingolimod-Associated Macular Edema in the Treatment of Multiple Sclerosis. Cureus 2023; 15:e41520. [PMID: 37551255 PMCID: PMC10404465 DOI: 10.7759/cureus.41520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 07/07/2023] [Indexed: 08/09/2023] Open
Abstract
Multiple sclerosis is a neurological disorder categorized by inflammatory processes with a high prevalence worldwide. It affects both motor and sensory pathways and is also associated with the visual pathway. Fingolimod is a commonly used drug for relapsing-remitting multiple sclerosis. It is a sphingosine 1-phosphate modulator acting on its receptors for immune cell accumulation, neuronal function, embryological development, vascular permeability, smooth muscle cell function, and endothelial barrier maintenance. This review aims to understand the processes, mechanisms, risks, and management of fingolimod-associated macular edema. Due to the anti-inflammatory properties of fingolimod, it decreases various cytokines, including interleukin (IL)-1B and IL-6, spike wave, and spike amplitude, in electrophysiological activities and decreases insoluble receptors for advanced glycation end product ligand. A daily dosage of 0.5 mg of fingolimod has an increased association with macular edema. The serious adverse events of fingolimod are lymphopenia, cardiovascular events, ocular events, and carcinoma. Fingolimod decreases brain volume and increases vascular permeability, resulting in increased macular volume and damage to the blood-retinal barrier, which causes an increased risk for macular edema. Cystoid macular edema is more common in older individuals suffering from comorbidities affecting the retina, such as diabetes, or those undergoing ophthalmological surgeries. This review also highlights the importance of regular ophthalmology examinations on patients consuming fingolimod both in the initial stages and chronic use. The treatment options for macular edema include nonsteroidal anti-inflammatory drugs, acetazolamide, triamcinolone, ketorolac, corticosteroids, and intravitreal procedures.
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Affiliation(s)
- Asma A Khan
- Medical School, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sai Dheeraj Gutlapalli
- Internal Medicine, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine, New York, USA
- Internal Medicine Clinical Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mehvish Sohail
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Priyansh Patel
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Baroda Medical College, Vadodara, IND
| | - Sidharth Midha
- Radiology, Bharati Vidyapeeth University, Pune, IND
- Radiology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Surmai Shukla
- Medicine and Surgery, Qingdao University College of Medical Science, Qingdao, CHN
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Divyanshu Dhamija
- Internal Medicine, Government Medical College Amritsar, Amritsar, IND
- General Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Adedamola O Bello
- Psychiatry, St. Martinus University Faculty of Medicine, Willemstad, USA
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Abeer O Elshaikh
- Internal Medicine/Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Toro J, Cuellar-Giraldo D, Díaz-Cruz C, Burbano LE, Guío CM, Reyes S, Cortes F, Cárdenas-Robledo S, Narváez DM, Cárdenas W, Porras A, Lattig MC, Groot de Restrepo H. HLA-DRB1*14 is a protective allele for multiple sclerosis in an admixed Colombian population. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2015; 3:e192. [PMID: 26740965 PMCID: PMC4694072 DOI: 10.1212/nxi.0000000000000192] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 11/03/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to determine ancestry informative markers, mitochondrial DNA haplogroups, and the association between HLA-DRB1 alleles and multiple sclerosis (MS) in a group of patients from Bogotá, Colombia. METHODS In this case-control study, genomic DNA was isolated and purified from blood samples. HLA-DRB1 allele genotyping was done using PCR. Mitochondrial hypervariable region 1 was amplified and haplogroups were determined using HaploGrep software. Genomic ancestry was estimated by genotyping a panel of ancestry informative markers. To test the association of HLA polymorphisms and MS, we ran separate multivariate logistic regression models. Bonferroni correction was used to account for multiple regression tests. RESULTS A total of 100 patients with MS (mean age 40.4 ± 12 years; 70% females) and 200 healthy controls (mean age 37.6 ± 11 years; 83.5% females) were included in the analysis. Ancestry proportions and haplogroup frequencies did not differ between patients and controls. HLA-DRB1*15 was present in 31% of cases and 13.5% of controls, whereas HLA-DRB1*14 was present in 5% of cases and 15.5% of controls. In the multivariate model, HLA-DRB1*15 was significantly associated with MS (odds ratio [OR] = 3.05, p < 0.001), whereas HLA-DRB1*14 was confirmed as a protective factor in our population (OR = 0.16, p = 0.001). CONCLUSIONS This study provides evidence indicating that HLA-DRB1*15 allele confers susceptibility to MS and HLA-DRB1*14 allele exerts resistance to MS in a highly admixed population. This latter finding could partially explain the low prevalence of MS in Bogotá, Colombia.
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Affiliation(s)
- Jaime Toro
- School of Medicine (J.T., D.C.-G., C.-M.G., S.R., F.C., A.P.), Universidad El Bosque, Bogotá, Colombia; Department of Neurology (J.T., D.C.-G., C.D.-C., L.-E.B., C.-M.G., S.R., S.C.-R.), Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; and School of Medicine (J.T., D.C.-G., C.D.-C., L.-E.B., S.R., D.M.N., H.G.d.R.) and Human Genetics Laboratory (D.C.-G., D.M.N., W.C., M.-C.L., H.G.d.R.), Department of Biological Sciences, Universidad de Los Andes, Bogotá, Colombia
| | - David Cuellar-Giraldo
- School of Medicine (J.T., D.C.-G., C.-M.G., S.R., F.C., A.P.), Universidad El Bosque, Bogotá, Colombia; Department of Neurology (J.T., D.C.-G., C.D.-C., L.-E.B., C.-M.G., S.R., S.C.-R.), Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; and School of Medicine (J.T., D.C.-G., C.D.-C., L.-E.B., S.R., D.M.N., H.G.d.R.) and Human Genetics Laboratory (D.C.-G., D.M.N., W.C., M.-C.L., H.G.d.R.), Department of Biological Sciences, Universidad de Los Andes, Bogotá, Colombia
| | - Camilo Díaz-Cruz
- School of Medicine (J.T., D.C.-G., C.-M.G., S.R., F.C., A.P.), Universidad El Bosque, Bogotá, Colombia; Department of Neurology (J.T., D.C.-G., C.D.-C., L.-E.B., C.-M.G., S.R., S.C.-R.), Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; and School of Medicine (J.T., D.C.-G., C.D.-C., L.-E.B., S.R., D.M.N., H.G.d.R.) and Human Genetics Laboratory (D.C.-G., D.M.N., W.C., M.-C.L., H.G.d.R.), Department of Biological Sciences, Universidad de Los Andes, Bogotá, Colombia
| | - Lisseth-Estefania Burbano
- School of Medicine (J.T., D.C.-G., C.-M.G., S.R., F.C., A.P.), Universidad El Bosque, Bogotá, Colombia; Department of Neurology (J.T., D.C.-G., C.D.-C., L.-E.B., C.-M.G., S.R., S.C.-R.), Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; and School of Medicine (J.T., D.C.-G., C.D.-C., L.-E.B., S.R., D.M.N., H.G.d.R.) and Human Genetics Laboratory (D.C.-G., D.M.N., W.C., M.-C.L., H.G.d.R.), Department of Biological Sciences, Universidad de Los Andes, Bogotá, Colombia
| | - Claudia-Marcela Guío
- School of Medicine (J.T., D.C.-G., C.-M.G., S.R., F.C., A.P.), Universidad El Bosque, Bogotá, Colombia; Department of Neurology (J.T., D.C.-G., C.D.-C., L.-E.B., C.-M.G., S.R., S.C.-R.), Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; and School of Medicine (J.T., D.C.-G., C.D.-C., L.-E.B., S.R., D.M.N., H.G.d.R.) and Human Genetics Laboratory (D.C.-G., D.M.N., W.C., M.-C.L., H.G.d.R.), Department of Biological Sciences, Universidad de Los Andes, Bogotá, Colombia
| | - Saúl Reyes
- School of Medicine (J.T., D.C.-G., C.-M.G., S.R., F.C., A.P.), Universidad El Bosque, Bogotá, Colombia; Department of Neurology (J.T., D.C.-G., C.D.-C., L.-E.B., C.-M.G., S.R., S.C.-R.), Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; and School of Medicine (J.T., D.C.-G., C.D.-C., L.-E.B., S.R., D.M.N., H.G.d.R.) and Human Genetics Laboratory (D.C.-G., D.M.N., W.C., M.-C.L., H.G.d.R.), Department of Biological Sciences, Universidad de Los Andes, Bogotá, Colombia
| | - Fabián Cortes
- School of Medicine (J.T., D.C.-G., C.-M.G., S.R., F.C., A.P.), Universidad El Bosque, Bogotá, Colombia; Department of Neurology (J.T., D.C.-G., C.D.-C., L.-E.B., C.-M.G., S.R., S.C.-R.), Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; and School of Medicine (J.T., D.C.-G., C.D.-C., L.-E.B., S.R., D.M.N., H.G.d.R.) and Human Genetics Laboratory (D.C.-G., D.M.N., W.C., M.-C.L., H.G.d.R.), Department of Biological Sciences, Universidad de Los Andes, Bogotá, Colombia
| | - Simón Cárdenas-Robledo
- School of Medicine (J.T., D.C.-G., C.-M.G., S.R., F.C., A.P.), Universidad El Bosque, Bogotá, Colombia; Department of Neurology (J.T., D.C.-G., C.D.-C., L.-E.B., C.-M.G., S.R., S.C.-R.), Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; and School of Medicine (J.T., D.C.-G., C.D.-C., L.-E.B., S.R., D.M.N., H.G.d.R.) and Human Genetics Laboratory (D.C.-G., D.M.N., W.C., M.-C.L., H.G.d.R.), Department of Biological Sciences, Universidad de Los Andes, Bogotá, Colombia
| | - Diana M Narváez
- School of Medicine (J.T., D.C.-G., C.-M.G., S.R., F.C., A.P.), Universidad El Bosque, Bogotá, Colombia; Department of Neurology (J.T., D.C.-G., C.D.-C., L.-E.B., C.-M.G., S.R., S.C.-R.), Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; and School of Medicine (J.T., D.C.-G., C.D.-C., L.-E.B., S.R., D.M.N., H.G.d.R.) and Human Genetics Laboratory (D.C.-G., D.M.N., W.C., M.-C.L., H.G.d.R.), Department of Biological Sciences, Universidad de Los Andes, Bogotá, Colombia
| | - Wilmer Cárdenas
- School of Medicine (J.T., D.C.-G., C.-M.G., S.R., F.C., A.P.), Universidad El Bosque, Bogotá, Colombia; Department of Neurology (J.T., D.C.-G., C.D.-C., L.-E.B., C.-M.G., S.R., S.C.-R.), Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; and School of Medicine (J.T., D.C.-G., C.D.-C., L.-E.B., S.R., D.M.N., H.G.d.R.) and Human Genetics Laboratory (D.C.-G., D.M.N., W.C., M.-C.L., H.G.d.R.), Department of Biological Sciences, Universidad de Los Andes, Bogotá, Colombia
| | - Alexandra Porras
- School of Medicine (J.T., D.C.-G., C.-M.G., S.R., F.C., A.P.), Universidad El Bosque, Bogotá, Colombia; Department of Neurology (J.T., D.C.-G., C.D.-C., L.-E.B., C.-M.G., S.R., S.C.-R.), Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; and School of Medicine (J.T., D.C.-G., C.D.-C., L.-E.B., S.R., D.M.N., H.G.d.R.) and Human Genetics Laboratory (D.C.-G., D.M.N., W.C., M.-C.L., H.G.d.R.), Department of Biological Sciences, Universidad de Los Andes, Bogotá, Colombia
| | - María-Claudia Lattig
- School of Medicine (J.T., D.C.-G., C.-M.G., S.R., F.C., A.P.), Universidad El Bosque, Bogotá, Colombia; Department of Neurology (J.T., D.C.-G., C.D.-C., L.-E.B., C.-M.G., S.R., S.C.-R.), Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; and School of Medicine (J.T., D.C.-G., C.D.-C., L.-E.B., S.R., D.M.N., H.G.d.R.) and Human Genetics Laboratory (D.C.-G., D.M.N., W.C., M.-C.L., H.G.d.R.), Department of Biological Sciences, Universidad de Los Andes, Bogotá, Colombia
| | - Helena Groot de Restrepo
- School of Medicine (J.T., D.C.-G., C.-M.G., S.R., F.C., A.P.), Universidad El Bosque, Bogotá, Colombia; Department of Neurology (J.T., D.C.-G., C.D.-C., L.-E.B., C.-M.G., S.R., S.C.-R.), Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; and School of Medicine (J.T., D.C.-G., C.D.-C., L.-E.B., S.R., D.M.N., H.G.d.R.) and Human Genetics Laboratory (D.C.-G., D.M.N., W.C., M.-C.L., H.G.d.R.), Department of Biological Sciences, Universidad de Los Andes, Bogotá, Colombia
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