Comparing the efficacy of monthly cyclophosphamide as monotherapy versus daily fingolimod in relapsing remitting and secondary progressive multiple sclerosis

Abstract

Background: The aim of this study was to determine the efficacy of monthly cyclophosphamide and daily fingolimod in treatment of patients with multiple sclerosis (MS) and to compare these two treatment strategies. Methods: In a clinical trial study, 30 patients with relapsing remitting multiple sclerosis (RRMS) were enrolled. 15 patients were treated by cyclophosphamide and 15 by fingolimod for six months. The expanded disability status scale (EDSS) score and relapse rate were measured and compared between the two groups. Findings: The mean differences of EDSS in the two groups were -0.03 ± 0.17 and 0.33 ± 0.18, respectively and the decrease of EDSS in fingolimod group was significantly higher than the cyclophosphamide group (P < 0.001). In the cyclophosphamide group, there were 4 patients without recurrence, 10 single and 1 double flares; while in fingolimod group, only 4 patients had a single relapse. The differences in after-treatment relapses among the two groups was statistically significant (P = 0.023). Conclusion: Using daily fingolimod is better than the cyclophosphamide for prevention of relapse and improvement of EDSS in patients with relapsing remitting multiple sclerosis; but treatment of multiple sclerosis with this drug depend on patient's clinical status, intensity of the disease, and idea of neurologist. However, more studies are recommended for determining the side effects in long term use of fingolimod. © 2017, Isfahan University of Medical Sciences(IUMS). All rights reserved.