MS: fingolimod tied to treatment-refractory HPV lesions

  • Triplett J & al.
  • Mult Scler
  • 14/11/2018

  • Susan London
  • Clinical Essentials
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Takeaway

  • Australian neurologists report 5 patients with multiple sclerosis (MS) who developed chronic, treatment-refractory cutaneous warts while receiving fingolimod (Gilenya).

Why this matters

  • Heightened risk for HPV-related disease may have implications for cancer prevention and screening.

Key results

  • 5 patients developed chronic cutaneous warts in differing sites (anus, ankle, foot, jaw, finger) associated with prolonged periods of lymphopenia.
  • Onset was 17-58 months after starting fingolimod.
  • Warts were refractory to treatment with imiquimod (Aldara, Zyclara), cryotherapy, and local excision.
  • The patient with anal disease had progression to metastatic HPV-associated squamous cell carcinoma.
  • In 3 cases with verruca vulgaris warts, the warts shrunk or resolved after fingolimod dose reduction or discontinuation.
  • Another recently reported case series documents 5 additional cases.

Expert comment

  • In a commentary, Gabrielle Macaron, MD, and Daniel Ontaneda, MD, write, "These observations shed light on the potential need to vaccinate patients for HPV before initiating fingolimod.... Since the vaccines do not cover all HPV subtypes, and patients are often older at diagnosis of MS, screening for HPV-related disease remains the main preventive measure."

Study design

  • Australian case series of 5 patients with relapsing-remitting MS who developed chronic, treatment-refractory warts associated with therapy.
  • Main outcomes: demographic and clinical features, clinical outcomes.
  • Funding: None.

Limitations

  • Small number of patients.
  • Potential confounding.