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Investigating Treatment Alternatives for Fingolimod in Patients With Multiple Sclerosis Developed Refractory Fingolimod-Related Genital Human Papilloma Virus (Hpv) Infection Publisher Pubmed



Paybast S1 ; Ashtari F2 ; Moghaddam NB3 ; Poursadeghfard M4 ; Abutorabi M5 ; Nahayati MA6 ; Shahmohammadi S7 ; Moghadasi AN7 ; Ebadi Z7 ; Heidari H8 ; Sahraian MA7
Authors
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Authors Affiliations
  1. 1. Department of Neurology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  2. 2. Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
  3. 3. of Neurology, Neurology Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  4. 4. Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  5. 5. Department of Neurology, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
  6. 6. Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashahd, Iran
  7. 7. Multiple Sclerosis Research Center, Neuroscience institute, Tehran University of Medical sciences, Tehran, Iran
  8. 8. Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH, United States

Source: Multiple Sclerosis and Related Disorders Published:2025


Abstract

Introduction: Genital human papillomavirus (HPV) infection is a rare skin complication in patients with relapse-remitting multiples sclerosis (RRMS) treated with fingolimod. Herein, we aimed to report a case series of 23 MS patients who had to discontinue fingolimod due to persistent HPV infection. Materials and methods: This retrospective case series was conducted between September 2023 to September 2024 in six MS centers in Iran to identify the outcome of HPV infection who discontinued fingolimod. Results: 23 patients with a mean age of 36.34 ± 6.90 -year-old. The majority of patients were female (78.3 %) with a mean disease duration of 3.83 ± 3.02 years, and a mean EDSS score of 1.26 ± 1.10 at the time of fingolimod initiation. Most patients (39.1%) were treatment naive. They developed genital HPV infection after a mean 32.21± 25.15 months of using fingolimod. Most patients (78.3%) were affected by low risk HPV infection and received a mean 1.96± 1.43 cycles of cryotherapy. After a mean 14.30±11.05 months, all patients had to discontinue treatment, mainly switched to anti-CD20 agents (78.3%). The lesions were resolved after a mean 4.52± 3.11 months. In addition, except for two patients developing a rebound after fingolimod cessations, others were stable with no evidence of disease activity or progression over a one-year follow-up. Conclusion: Our preliminary results revealed that anti-CD20s agents could be considered safe in patients treated with fingolimod who had to discontinue treatment due to persistent HPV infection. Larger studies are needed to warrant our data. © 2025