Clinical exacerbation of SARS‐CoV2 infection after fingolimod withdrawal

• Published in: Journal of Medical Virology Vol. 93; no. 1; pp. 546 - 549
• Main Authors: Gomez‐Mayordomo, Victor, Montero‐Escribano, Paloma, Matías‐Guiu, Jordi A., González‐García, Nuria, Porta‐Etessam, Jesús, Matías‐Guiu, Jorge
• Format: Journal Article Web Resource
• Language: English
• Published: United States John Wiley & Sons, Inc 01.01.2021; Wiley Subscription Services, Inc; John Wiley and Sons Inc
• Subjects: Autoimmune diseases; Coronaviridae; coronavirus; Coronaviruses; COVID-19; COVID-19 - pathology; Cytokines; exacerbation; fingolimod; Fingolimod Hydrochloride - administration & dosage; Fingolimod Hydrochloride - therapeutic use; Humans; Immune response; Immune system; Immunocompromised hosts; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - therapeutic use; Infections; Inflammation; Lymph nodes; Lymphocytes; Male; Middle Aged; Multiple sclerosis; Multiple Sclerosis, Relapsing-Remitting - drug therapy; Respiratory diseases; RNA, Viral; SARS-CoV-2; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Short Communication; Short Communications; Viral diseases; Virology; COVID-19; coronavirus; SARS-CoV-2; fingolimod; multiple sclerosis; exacerbation
• ISSN: 0146-6615; 1096-9071
• DOI: 10.1002/jmv.26279

The role of disease‐modifying therapies in patients with autoimmune disorders during severe acute respiratory syndrome coronavirus 2 (SARS‐CoV2) infection is controversial. Immunocompromised patients could have a more severe coronavirus disease‐2019 (COVID‐19) due to the absence of an adequate immune response against the SARS‐CoV‐2. However, therapies that act on immune response could play a protective role by dampening the cytokine‐release syndrome. Fingolimod is a drug used for immune therapy in patients with multiple sclerosis (MS) through the sequestration of activated lymphocytes in the lymph nodes. We report the case of a 57‐year‐old man with relapsing‐remitting MS treated with fingolimod that showed a reactivation of COVID‐19 with signs of hyperinflammation syndrome after fingolimod withdrawal. Our case suggests that discontinuation of fingolimod during COVID‐19 could imply a worsening of SARS‐CoV2 infection. Highlights We report a patient with Multiple Sclerosis presenting COVID‐19 when treated with fingolimod. Hyperinflammation syndrome was observed after fingolimod withdrawal. Discontinuation of fingolimod during COVID‐19 could imply a worsening of SARS‐CoV‐2 infection.