Alternate dosing of fingolimod in relapsing-remitting multiple sclerosis: A systematic review

Background: Fingolimod is approved in relapsing-remitting multiple sclerosis (RRMS) with the recommended dose of 0.5 mg daily. To tackle possible adverse events, some clinicians may reduce the dose of fingolimod, mainly in the alternate-day form. We systematically reviewed the literature for efficacy measures of this method. Methods: PubMed (Medline®), Web of Science, Embase, Scopus, and the Cochrane Library databases were searched until April 9, 2021. Clinical studies (other than case reports and case series), in English, were included. Then, publications concerning alternate dose fingolimod (including every other day, every two or three days) were selected. Those studies concerning reduced daily dose (any daily dose less than 0.5 mg/day) were excluded to focus on alternate dosing. Results: Four observational studies were included. Data on Ohtani et al. study were limited. Three other studies were of good quality based on the Newcastle-Ottawa Scale. A total of 296 patients on the standard dose were compared to 276 patients on the alternate dosage. The most common reason for switching to the alternate dose was lymphopenia, followed by elevated liver enzymes. Two studies concluded that the alternate dosing could be a safe, yet effective strategy in patients with intolerable adverse effects of daily dose. However, Zecca et al. warned about the high possibility of disease reactivation. Due to the differences in outcome measures of the studies, meta-analysis was not applicable. Conclusion: This systematic review highlights the ambiguity of evidence on safety and efficacy of alternate dosing of fingolimod, encouraging further research on the subject.

The Daily Dose: Utilizing WhatsApp to engage pharmacy students in clinical discussion

BACKGROUND AND PURPOSE

There are many challenges associated with longitudinally applying therapeutic knowledge in the pharmacy curriculum. This study investigated student participation using the messaging platform, WhatsApp (Meta Platforms, Inc.), as a discussion-based platform for pharmacy students.

EDUCATIONAL ACTIVITY AND SETTING

The created WhatsApp group chat discussion, "The Daily Dose," was a longitudinal learning experience occurring during pharmacy students' last year of clinical rotations or third year of didactic learning. Students were asked daily clinical questions in the application and participation was primarily assessed. This study included a pre-survey, discussion participation assessment, and a post-survey. The surveys assessed student self-evaluations of their learning, clinical confidence levels, board preparedness, and program learning experience feedback.

FINDINGS

A total of 115 questions were asked and 37 students voluntarily joined. Students participated by responding to 97% of questions. Of the 37 students who joined, 81% were experiential education students and 19% were didactic education students. A moderator needed to prompt for participation for 34% of the questions. The majority of students (95%) learned something new. Experiential education students were more likely to participate than didactic education students. A moderator may be beneficial to keep the discussion active. Students' self-evaluations of clinical confidence and board preparedness increased after participating in The Daily Dose.

SUMMARY

The Daily Dose is an innovative way to engage student discussion and reinforce pharmacy therapeutic knowledge. This tool could be expanded to use with multiple pharmacy learners.