Fingolimod (Gilenya) This factsheet is about fingolimod, a Whether you’ll be offered this or any other DMT disease modifying therapy (DMT) for depends on whether you qualify for it based relapsing multiple sclerosis (MS). on guidelines used by your neurologist. These come from NICE and the Association of British At the end of this factsheet you’ll find out where Neurologists and are based on a drug’s Europe- you can get more information on this drug, other wide licence. drugs for MS and the benefits of early treatment. In England there are also rules from NHS England about who can have the different DMTs and when. This factsheet doesn’t cover everything about Scotland, Wales and Northern Ireland also have this drug and shouldn’t be used in place of their own guidelines for many DMTs. advice from your MS specialist team. For more information speak to them and read the online information from the drug’s makers (see the Whether you can have a drug also depends on section More information and support). if the NHS where you live will pay for it. NHS England guidelines on this tend to follow what What is fingolimod? NICE says. Fingolimod is a drug that was first given a licence These people can have fingolimod: to be used against relapsing MS in the UK in 2011. In England and Northern Ireland: In 2012 the National Institute for Health and Care Excellence (NICE) gave the go ahead for it to be • People with ‘highly active relapsing remitting used on the NHS. It was the first DMT you take as MS’. This means they’re getting the same a tablet. or an increased number of relapses despite treatment with beta interferon (Avonex, Rebif, Fingolimod is pronounced: finn-GOLLY-mod. Betaferon, Extavia or Plegridy), glatiramer Its brand name is Gilenya (jill-EN-ee-yer). acetate (Copaxone), dimethyl fumarate or teriflunomide (Aubagio) Can I have this drug? In Scotland and Wales: Fingolimod is recommended for the treatment of • People with ‘highly active relapsing remitting ‘highly active’ relapsing MS. ‘Highly active’ means MS’ who have failed to respond to a DMT that, even though you’re taking a DMT, you’re still getting relapses and MRI scans show signs that • People who have ‘rapidly evolving severe your MS is active. These signs include new ‘lesions’ relapsing remitting MS’. This means they’ve (areas of damage) in your brain or spinal cord. had two or more disabling relapses in one year and an increase in lesions as shown on two MRI scans You can also have fingolimod if you’re not on a DMT but are having frequent relapses and/or new Across the UK: lesions can be seen on your MRI scans. People on natalizumab (Tysabri) at high risk of DMT factsheet: fingolimod (Gilenya) developing a serious brain infection called PML problems. After this first dose you take all other might be switched to fingolimod. doses at home. The 2015 guidance from the Association of British Neurologists (ABN) suggests that fingolimod How does it work? can also be the first drug that’s given to people Your immune system fights off infections. But if they have ‘highly active’ relapsing MS. For with MS it attacks parts of your brain and spinal people in England new rules from NHS England cord by mistake. This leads to inflammation and allow fingolimod to be your first DMT if you have damage, especially to the coating that covers ‘rapidly evolving severe relapsing remitting MS’ your nerves (myelin). This damage interferes with and you’re not suitable for natalizumab. how signals travel along these nerves. Over time this affects your control over many parts of your You won’t get this drug if: body and causes symptoms of MS. • you’re already on another DMT that’s Immune cells called white blood cells or controlling your MS well. You can’t take more ‘lymphocytes’, especially ones called T and B cells, than one DMT at a time are thought to be responsible for much of the damage MS causes. Fingolimod sticks to these • you have progressive MS. A trial in 2014 cells, stopping many of them leaving your lymph showed that fingolimod won’t help people nodes where they’re made. This means far fewer of with primary progressive MS. You also won’t them reach your brain and spinal cord where they be offered it if you have secondary progressive would attack the myelin coating of your nerves. MS. But several drugs are being tested to see if they work for people with these non- Fingolimod doesn’t affect other cells in your relapsing, progressive types of MS. immune system, so your body can still fight off • you have some health conditions. So tell infections, though not quite as well as before. your MS specialist your full medical history, including any other health problems and This drug might also directly stop nerves from medications you’re taking being damaged or help repair them. • you’re a woman who wants to become pregnant or is pregnant. How well does fingolimod Fingolimod can harm babies in the womb. If work? you’re a woman taking this drug, you must When DMTs, including fingolimod, are working use reliable contraception while on it. If you well you have: stop taking the drug, you need to keep using contraception for two months afterwards. Discuss • fewer and less serious relapses with your neurologist if you want to get pregnant • fewer new or bigger lesions in your brain and (see the sections What side effects might I get? spinal cord (lesions can be seen on MRI scans) and I want a child. Can I take fingolimod?). • a slowdown in your disability getting worse Like other DMTs, fingolimod works best the How do I take it? sooner you start it after you’re diagnosed with Fingolimod is a tablet you take once a day. You’re MS. Taking it later can also have benefits but it given your first dose in hospital and you’ll be can’t undo any permanent disability you may monitored for at least six hours to check for already have. 2 Helpline: 0808 800 8000 DMT factsheet: fingolimod (Gilenya) DMTs can be split into three groups, according to how big their effect on MS can be. High (they can work very well): • dimethyl fumarate (Tecfidera) • alemtuzumab (Lemtrada) • fingolimod (Gilenya) • natalizumab (Tysabri) Moderate (they can work fairly well) • haematopoietic stem cell transplantation • glatiramer acetate (Copaxone and Brabio) • ocrelizumab (Ocrevus) when used for • five different beta interferons (Avonex, relapsing MS Betaferon, Extavia, Rebif and Plegridy) Good (they can work well): • teriflunomide (Aubagio) • cladribine (Mavenclad) • ocrelizumab (Ocrevus) when used for early primary progressive MS The effectivesness of fingolimod is classed as ‘good’ GOOD Relapses dropped by 54% compared to a placebo This means that in a trial, on average, people saw the number of relapses they had drop by 54% (they had half as many relapses). This was compared to people who took a placebo, a dummy pill with no drug in it. How many people stayed free of relapses when they took fingolimod? Trial one 70% of people on fingolimod stayed free of relapses over two years. 46% of people who took the placebo stayed free of relapses. = no relapses mssociety.org.uk 3 DMT factsheet: fingolimod (Gilenya) Trial two 83% of people in another trial who took fingolimod stayed free of relapses over one year. 70% of people who instead took beta interferon, a standard MS treatment, stayed free of relapses. Disability getting worse was slowed down by 30% compared to a placebo This means that in a trial, on average, people saw a 30% drop in the risk of their disability getting worse. This was compared to people who took a placebo. How many people’s disability didn’t get worse when they took fingolimod? Disability didn’t get worse over two years for 82% of people who took fingolimod. Disability didn’t get worse for 76% of people who took a placebo. = disability didn’t get worse In another trial 94% of people on fingolimod saw no worsening of their disability over one year compared to 92% of people who took beta interferon. This difference isn’t big enough to be statistically significant (it might have happened by chance, not because of the drug). These figures come from a clinical trial called FREEDOMS, which followed 1,280 people for two years and a trial called TRANSFORMS, which followed around 1,000 people over one year. Fingolimod might work much better for you than these average results - or it might not work as well. 4 Helpline: 0808 800 8000 DMT factsheet: fingolimod (Gilenya) What side effects might Side effects that could be more serious: heart I get? • your heart beat may temporarily slow down or Like all drugs, fingolimod can have side effects, become irregular, especially after your first dose but not everyone gets them. Not many people • up to one in ten people get an irregular or stop taking this drug because of side effects. slow heart beat but it only caused symptoms (dizziness, tiredness and palpitations) for less The more effective a DMT is, the more risk of than one in a 100 people in one large trial serious side effects. Fingolimod is somewhere between the less effective drugs with fewer side • you’re given your first dose of fingolimod in effects (beta interferons and glatiramer acetate) hospital and monitored for at least six hours and the harder hitting drugs with more serious after taking it to check for problems ones (like alemtuzumab and natalizumab).