Real-world effectiveness of fingolimod in patients with multiple sclerosis in Bulgaria

Introduction. Fingolimod, a sphingosine-1-phosphate receptor agonist used for the treatment of multiple sclerosis (MS). Our goal was to assess the impact of fingolimod on quality of life in patients with relapsing-remitting multiple sclerosis (RRMS) after 2 years of treatment in this real-world study. Patients and methods. This was a 2-year, prospective, observational study conducted in Bulgaria in RRMS patients treated with fingolimod. Quality of life was assessed using the Bulgarian-language version of the MSQoL-54 scale. The primary endpoint was the change from baseline in the MSQoL-54 score after 2 years of treatment. Secondary endpoints included the change from baseline in the MSQoL-54 score after one year of treatment, furthermore the assessment of depression level using the Hamilton D-17 score. Results. A total of 87 eligible patients were included in the study with a mean age of 38.7 +/- 8.45 years. The median Expanded Disability Status Scale (EDSS) score was 3.5 points. We found statistically significant improvement in 10 subscales at month 12 and in seven subscales at month 24. The mental health composite score increased from 64.0 +/- 16.69 points to 67.5 +/- 15.94 points at month 24 (p = 0.012). The physical health composite score increased from 61.7 +/- 17.61 to 66.3 +/- 16.70 (p = 0.001). Depression level measured by the HAM-D17 decreased significantly by month 12 and month 24. The EDSS score decreased or remained stable in more than half of the patients (61.6%). We detected better quality of life in patients with a lower EDSS score. Conclusions. Quality of life scores and the depression level are improved in RRMS patients treated with fingolimod over 2 years in real-life setting.