To describe our clinical experience with Fingolimod at Cleveland Clinic Abu Dhabi in Emirati patients with multiple sclerosis (MS).

In clinical trials, Fingolimod was an efficacious and safe treatment for relapsing remitting (RR) MS. Despite this, few studies have explored its real-world efficacy and safety in the Middle East.

We retrospectively collected clinical and brain/spinal cord MRI activity over time of 30 Emirati MS patients [24 RR and 6 clinically isolated syndromes, F/M=22/8, mean±SD disease duration at treatment initiation=3.3±3.6years, age at onset =25.9±6.9years, and treatment duration=1.4 ± 0.6years] who were commenced on Fingolimod from 2015.  The proportion of MS patients clinically and/or radiologically silent after Fingolimod initiation over time and its association with pre-treatment clinical and MRI parameters was assessed using a Cox regression analysis. Adverse events (AEs) occurrence was also assessed.

67.7% of MS patients were naïve. Mean±SD number of relapses total and after Fingolimod were respectively 2.9± 1.5 and 0.5± 0.8. Pre-treatment MRI activity was present in 40% patients. Over time, relapses and evidence of MRI activity were found correspondingly in 30% and 53% patients and the proportion of patients who remained clinically and/or radiologically silent was 36.7%. The risk of not being clinically and/or radiologically silent was associated with higher pre-treatment MRI activity and higher total number of relapses (p=0.018 and p=0.02). Mild AEs were observed in 33% of MS patients and consisted in leucopenia (13%), slight increase in liver enzymes (6.6%), fatigue (6.6%), bradycardia (3.3%), headache (3.3%) and hair loss (3.3%).

In Emirati MS patients, Fingolimod is safe as early treatment choice. Its medium term effectiveness is predicted by pre-treatment clinical and MRI activity suggesting that a personalized treatment selection strategy in our population could be exercised.