MS Therapy Gilenya Found Effective for Treating Man With Both MS, HAE
An approved therapy for multiple sclerosis (MS), called Gilenya (fingolimod), was effective at treating a man who had a rare combination of MS and hereditary angioedema (HAE), researchers in Greece have found.
“We report [a] case study of a patient with concurrence of HAE and MS, discussing the possible association between these two diseases. Oddly enough, remission in both diseases was observed following treatment for MS with [Gilenya],” the scientists wrote.
Their study, “Co-occurrence between hereditary angioedema and multiple sclerosis: Therapeutic management of both diseases with fingolimod,” was published in the journal Clinical Neurology and Neurosurgery.
A 33-year-old man whose twin brother had previously been diagnosed with HAE was admitted to a hospital due to paralysis on the right side of his face. MRI scans revealed multiple lesions in the man’s brain and spinal cord that were characteristic of MS, an autoimmune neurodegenerative disease that causes inflammation and damage in the central nervous system (brain and spinal cord).
The man was diagnosed with clinically isolated syndrome (a first instance of MS-like disease). Treatment with inflammation-suppressing corticosteroids eased his immediate symptoms, and he was then started on glatiramer acetate (sold under the brand name Copaxone), a medication approved to slow MS progression.
Six months later, the man experienced sudden swelling on his scrotum. Given his family history, this was deemed to likely be a first clinical manifestation of HAE. Additional testing found that he carried a HAE-causing mutation in the SERPING1 gene, confirming the diagnosis. The man experienced three more swelling attacks — affecting his scrotum and legs — over the next four months.
After 11 months on glatiramer acetate, the man experienced an MS relapse causing symptoms of vision impairment and eye pain. Corticosteroids were again effective for managing these acute symptoms.
The patient was then switched from glatiramer acetate to another disease-modifying MS therapy, called Gilenya. This oral therapy works by “trapping” immune cells inside structures called lymph nodes, effectively preventing them from reaching the brain and spinal cord and causing inflammation.
The man showed no additional signs or symptoms of MS for three years on Gilenya. He also did not experience additional HAE attacks during this time, though he had some mild swelling in his hands and feet four years after starting the treatment (near the end of follow-up for this report).
“Significant remission was observed in both diseases following treatment for MS with [Gilenya]; this could indicate an effect of [Gilenya] in immunoregulatory pathways implicated in both diseases,” the researchers wrote, noting a need for further investigation into the potential mechanisms by which Gilenya might help prevent HAE-related swelling.
Gilenya is marketed by Novartis. The company was not involved in this study, though several of the researchers disclosed having received previous funding from Novartis.
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