Real-world comparison of lymphopenia profiles in S1P receptor modulators for multiple sclerosis: a multicenter retrospective study
Year: 2025
Type: article
Study design: Observational Study
Abstract: INTRODUCTION: Sphingosine-1-phosphate (S1P) receptor modulators, regulating the S1P/S1PR pathway, lead to lymphocyte sequestration in lymphoid organs, which results in peripheral lymphopenia. This study evaluates the degree of lymphopenia induced by S1P modulators in people with Multiple Sclerosis (MS): Ozanimod, Siponimod, Ponesimod, and Fingolimod. METHODS: We conducted a retrospective multicenter study across thirteen MS centers in Italy, including 191 MS patients (mean age 46.4 years; 61.3% women). Of these, 28.8% received Siponimod, 26.2% Ozanimod, 24.1% Fingolimod, and 20.9% Ponesimod. Lymphocyte counts were measured at baseline (T0), one month (T1), three months (T3), and six months (T6) post-treatment. Lymphopenia grades range from 0 (≥ 1.0 × 10^9 cells/L) to 4 (< 0.2 × 10^9 cells/L), according to Common Terminology Criteria for Adverse Events. RESULTS: At T1, Ozanimod showed a significantly higher mean lymphocyte count than Siponimod and Fingolimod (p < 0.001), Ponesimod higher mean lymphocyte count than Siponimod (p = 0.006). The differences persisted between Ozanimod than Siponimod and Fingolimod at T3 (p = 0.01 and p = 0.04), and between Ponesimod and Siponimod at T6 (p = 0.03). Severe lymphopenia cases were significantly higher in Siponimod than in Ponesimod and Ozanimod, at T1 (p = 0.001 and p = 0.0001). The differences remained significant between Ozanimod and Siponimod, at T3 (p = 0.001), and between Ponesimod and Siponimod, Fingolimod and Ozanimod, at T6 (p = 0.001). Grade 4 lymphopenia was observed in Ozanimod and Siponimod at T3. CONCLUSION: This is the first real-world, head-to-head observational study comparing lymphopenia among different S1P modulators. Our results might assist in therapy choice depending on patients baseline hematological characteristics.
Source: Journal of Neurology
Authors: Giorgia Teresa Maniscalco, Maddalena Sparaco, Maria Di Gregorio, Giuseppina Cafasso, Elisabetta Signoriello, Felice Romano, Rosa Iodice, Roberta Fantozzi, Paolo Bellantonio, Aurora Zanghi, Leonardo Sinisi, Alessandro D’Ambrosio, Vincenzo Busillo, Valentina Scarano, Rocco Capuano, Luigi Lavorgna, Michela Williams, Antonio De Martino, Maria Elena Di Battista, Daniele Di Giulio Cesare, Giacomo Lus, Emanuele Cassano, Paola Sofia Di Filippo, Grazia Sibilia, Gianmarco Abbadessa, Vincenzo Andreone, Simona Bonavita
Institutions: Ospedale Antonio Cardarelli, University of Naples Federico II, University of Campania "Luigi Vanvitelli", AOU San Giovanni di Dio e Ruggi d'Aragona, Azienda Ospedaliera S.Giuseppe Moscati, Federico II University Hospital, Istituto Neurologico Mediterraneo, University of Foggia, Azienda Sanitaria Locale Salerno
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,790
OpenAlex ID: W4413019254