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Chronic HPV associated lesions associated with Fingolimod use

Kermode, A.G. and Triplett, J.D. (2018) Chronic HPV associated lesions associated with Fingolimod use. Multiple Sclerosis Journal, 25 (3). pp. 460-461.


Background: Fingolimod is a an effective immunosuppressive therapy used to reduce relapse rates in relapsing remitting MS. Fingolimod is a sphingosine 1-phosphate (S1-P) analogue and has antagonistic effects on S1-P receptors causing in S1-P receptor internalization and degradation resulting in reduced circulating lymphocyte numbers. The reduced lymphocyte numbers associated with fingolimod are associated with increased rates and severity of viral infections particularly varicella zoster and may be associated with impaired intrinsic cancer surveillance.

Objective: To describe 5 cases of chronic and treatment refractory warts associated with fingolimod therapy and discuss practical implications for patients and clinicians.

Methods: Retrospective case series. Patients identified from 2 large multiple sclerosis clinics in Australia.

Results: Five cases of chronic warts where identified in patients receiving fingolimod therapy. Each patient had prolonged periods of lymphopenia associated with fingolimod use. Improvement or resolution of warts was only seen once fingolimod dose was reduced or ceased.

Conclusions: Cutaneous warts are associated with human papilloma virus (HPV) infection, suggesting an increased risk of other HPV driven conditions such as cervical cancer and non-melanoma associated skin cancer following fingolimod administration. HPV viruses are responsible for approximately 90% of cervical cancers as well as a significant portion of anogenital cancers and have a high prevalence in sexually active adults. Given the reduced immune response to viral infections and potential impaired cancer surveillance in those receiving fingolimod, HPV vaccination and frequent assessment for the development of HPV associated malignancies is recommended.

Item Type: Journal Article
Murdoch Affiliation(s): Institute for Immunology and Infectious Diseases
Publisher: Sage Publications
Other Information: Poster presentation - PACTRIMS 2018
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