Hostname: page-component-848d4c4894-nr4z6 Total loading time: 0 Render date: 2024-05-08T18:07:04.689Z Has data issue: false hasContentIssue false

Fingolimod-related atrioventricular block in paediatric age group with multiple sclerosis: two case reports

Published online by Cambridge University Press:  12 May 2023

Yunus E. Kum*
Affiliation:
Erciyes University Faculty of Medicine Pediatric Cardiology Department, Kayseri, Turkey
Özge Pamukçu
Affiliation:
Erciyes University Faculty of Medicine Pediatric Cardiology Department, Kayseri, Turkey
Mehmet Canpolat
Affiliation:
Erciyes University Faculty of Medicine Pediatric Neurology Department, Kayseri, Turkey
*
Corresponding author: Dr Y. E. Kum, Erciyes University Children’s Hospital, Köşk District, Prof. Dr. Turhan Feyzioğlu Street No: 42, 38039 Melikgazi, Kayseri, Turkey. Email: kumyek@hotmail.com

Abstract

Multiple sclerosis is a chronic inflammatory and demyelinating disease of the central nervous system, usually seen in young adults. Early onset of multiple sclerosis at age younger than 18 years is called paediatric multiple sclerosis. Unlike adult multiple sclerosis, paediatric multiple sclerosis causes morbidity at earlier ages and often progresses in a relapsing–remitting form. Although fingolimod is an effective drug used as a disease-modifiying therapy agent in relapsing–remitting paediatric multiple sclerosis patients, it can cause dysryhthmia in the early period after first dose. Our first case is a 14-year-old girl with relapsing–remitting paediatric multiple sclerosis patients who was started to take fingolimod treatment. In the fifth hour of the follow-up, asymptomatic bradycardia was seen and the electrocardiogram was consistent with first-degree atrioventricular block. Her rhythm got spontaneously normal after 12 hours. Second case was 13 years old girl. Steroid treatment was started after her first paediatric multiple sclerosis attack. Despite treatment, she had a second attack 2 weeks after the first attack. Therefore, the neurologist switched to fingolimod therapy. Second-degree atrioventriculer block developed after 4 hours from the initiation of therapy. After 8 hours, rhythm regressed to first-degree atrioventricular block then returned to normal up to 13th hours of follow up. The aim of this article is to draw attention to dysrhythmia side effect of fingolimod which can be fatal. Therefore, the clinician must take precautions. Close cardiac rhythm monitoring is mandatory after the initiation fingolimod theraphy.

Type
Brief Report
Copyright
© The Author(s), 2023. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Brola, W, Steinborn, B. Pediatric multiple sclerosis - current status of epidemiology, diagnosis and treatment. Neurol Neurochir Pol. 2020; 54: 508517.10.5603/PJNNS.a2020.0069CrossRefGoogle ScholarPubMed
Gorman, MP, Healy, BC, Polgar-Turcsanyi, M, Chitnis, T. Increased relapse rate in pediatric-onset compared with adult-onset multiple sclerosis. Arch Neurol 2009 Jan; 66: 5459.10.1001/archneurol.2008.505CrossRefGoogle ScholarPubMed
Banwell, B, Reder, AT, Krupp, L, et al. Safety and tolerability of interferon beta-1b in pediatric multiple sclerosis. Neurology 2006 Feb 28; 66: 472476.10.1212/01.wnl.0000198257.52512.1aCrossRefGoogle Scholar
Chitnis, T, Arnold, D, Banwell, B, PARADIGMS Study Group, et al. Trial of fingolimod versus interferon beta-1a in pediatric multiple sclerosis. N Engl J Med 2018; 379: 10171027.10.1056/NEJMoa1800149CrossRefGoogle ScholarPubMed
Huwiler, A, Zangemeister-Wittke, U. The sphingosine 1-phosphate receptor modulator fingolimod as a therapeutic agent: recent findings and new perspectives. Pharmacol Ther 2018 May; 185: 3449.10.1016/j.pharmthera.2017.11.001CrossRefGoogle ScholarPubMed
Petruzzo, M, Lanzillo, R. Asymptomatic bradycardia after first fingolimod dose in a pediatric patient with multiple sclerosis - a case report. Neurol Sci 2021 May; 42: 3739.10.1007/s10072-021-05086-5CrossRefGoogle Scholar
Franklin, MA, Happe, LE, Dillman, R, Marshall, LZ. Frequency and economic impact of comorbid cardiac conditions with multiple sclerosis. J Manag Care Spec Pharm 2014 Aug; 20: 795799.Google ScholarPubMed
Zanetta, C, Filippi, M, Moiola, L. Fingolimod as an effective therapeutic strategy for pediatric relapsing-remitting multiple sclerosis: two case reports. Neurol Sci 2021 May; 42: 913.10.1007/s10072-021-05270-7CrossRefGoogle ScholarPubMed