James Triplett1, Allan G Kermode2, Alastair Corbett3, Stephen W Reddel3. 1. Department of Neurology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia/ Department of Neurology, Concord Hospital, Concord, NSW, Australia. 2. Department of Neurology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia/ Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia/ Centre for Neuromuscular and Neurological Disorders, Perron Research Institute, Perth, WA, Australia/ Institute of Immunology and Infectious Diseases, Murdoch University, Perth, WA, Australia. 3. Department of Neurology, Concord Hospital, Concord, NSW, Australia/ Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
Abstract
BACKGROUND: Fingolimod is used to reduce relapse rates in relapsing-remitting multiple sclerosis (MS). It is a sphingosine 1-phosphate (S1P) analogue having antagonistic effects on S1P receptors. Its immunosuppressive effect is due to reduced circulating lymphocyte numbers, and it may also be associated with impaired intrinsic cancer surveillance. Fingolimod side effects include increased rates and severity of viral infections particularly varicella zoster. METHODS: We present five cases of chronic and treatment refractory warts associated with fingolimod therapy. RESULTS: Each of the five cases presenting with chronic warts while receiving fingolimod therapy had prolonged periods of lymphopenia and improvements were seen following dose reduction or cessation of fingolimod. CONCLUSION: Cutaneous warts are associated with human papilloma virus (HPV) infection, suggesting an increased risk of other HPV-driven conditions such as cervical 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 are recommended.
BACKGROUND:Fingolimod is used to reduce relapse rates in relapsing-remitting multiple sclerosis (MS). It is a sphingosine 1-phosphate (S1P) analogue having antagonistic effects on S1P receptors. Its immunosuppressive effect is due to reduced circulating lymphocyte numbers, and it may also be associated with impaired intrinsic cancer surveillance. Fingolimod side effects include increased rates and severity of viral infections particularly varicella zoster. METHODS: We present five cases of chronic and treatment refractory warts associated with fingolimod therapy. RESULTS: Each of the five cases presenting with chronic warts while receiving fingolimod therapy had prolonged periods of lymphopenia and improvements were seen following dose reduction or cessation of fingolimod. CONCLUSION: Cutaneous warts are associated with human papilloma virus (HPV) infection, suggesting an increased risk of other HPV-driven conditions such as cervical 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 are recommended.
Entities:
Keywords:
Fingolimod; human papilloma virus; malignancy; multiple sclerosis; relapsing/remitting; warts
Authors: Evgeny Berdyshev; Elena Goleva; Irina Bronova; Anna Sofia Bronoff; Joanne E Streib; Kathryn A Vang; Brittany N Richers; Patricia Taylor; Lisa Beck; Miguel Villarreal; Keli Johnson; Gloria David; Mark K Slifka; Jon Hanifin; Donald Y M Leung Journal: J Allergy Clin Immunol Date: 2022-03-15 Impact factor: 14.290