Fingolimod: therapeutic mechanisms and ocular adverse effects
Fingolimod: therapeutic mechanisms and ocular adverse effects
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作者：
Mandal, P.;Gupta, A.;Yang, Y.
芬戈莫德是一种口服免疫调节药物，用于治疗复发缓解型多发性硬化症（RRMS）。我们的目的是审查已发表的文献中芬戈莫德治疗的眼部表现及其可能的潜在机制。芬戈莫德的治疗作用通过鞘氨醇受体介导，鞘氨醇受体普遍存在于各种器官中，包括淋巴细胞、中枢神经系统、心肌细胞和平滑肌细胞。芬戈莫德相关性黄斑水肿（FAME）是最常见的眼部副作用，但可能发生视网膜出血和视网膜静脉阻塞。视觉后果似乎是轻微的，在FAME的情况下，解决往往是实现与中断治疗。然而，在视网膜静脉阻塞的情况下，单独停用芬戈莫德可能是不够的，可能需要玻璃体内治疗。我们还提出了一个务实的服务途径，监测患者的芬戈莫德治疗，其中包括分层的风险和视力。
Fingolimod is an oral immunomodulating drug used in the management of relapsing-remitting multiple sclerosis (RRMS). We aim to review the published literature on ocular manifestations of fingolimod therapy and their possible underlying mechanisms. The therapeutic effects of fingolimod are mediated via sphingosine receptors, which are found ubiquitously in various organs, including lymphoid cells, central nervous system, cardiac myocytes, and smooth muscle cells. Fingolimod-associated macular oedema (FAME) is the most common ocular side effect but retinal haemorrhages and retinal vein occlusion can occur. The visual consequences appear to be mild and, in cases of FAME, resolution is often attained with discontinuation of therapy. However, in cases of retinal vein occlusion, discontinuation of fingolimod alone may not be sufficient and intra-vitreal therapy may be required. We also propose a pragmatic service pathway for monitoring patients on fingolimod therapy, which includes stratifying them by risk and visual acuity.