Drug Interactions between fingolimod and typhoid vaccine, live

GENERALLY AVOID: The administration of live, attenuated viral or bacterial vaccines during fingolimod therapy may be associated with a risk of disseminated infection due to enhanced replication of vaccine virus or bacteria in the presence of diminished immune competence. Fingolimod causes reversible sequestration of lymphocytes in lymphoid tissues. A dose-dependent reduction in peripheral lymphocyte count to 20% to 30% of baseline values has been observed, which may increase the risk of infections. Vaccination may also be less effective during and for up to two months after discontinuation of fingolimod therapy. In healthy volunteers administered keyhole limpet Hemocyanin (KLH) and pneumococcal polysaccharide vaccine (PPV-23), antigen-specific IgM titers were decreased by 91% and 25% in response to KLH and PPV, respectively, in subjects receiving fingolimod 0.5 mg compared to placebo. Similarly, IgG titers were decreased by 45% and 50% in response to KLH and PPV, respectively, in subjects receiving fingolimod 0.5 mg compared to placebo. The responder rate for fingolimod 0.5 mg as measured by the number of subjects with a >4-fold increase in KLH IgG was comparable to placebo and 25% lower for PPV-23 IgG, while the number of subjects with a >4 fold increase in KLH and PPV-23 IgM was 75% and 40% lower, respectively, compared to placebo.

MANAGEMENT: The use of live attenuated vaccines should be avoided during and for two months after treatment with fingolimod. In patients who have recently been vaccinated, fingolimod therapy should be postponed for one month to allow the full effect of vaccination to occur. Administration of live attenuated vaccines in severely immunocompromised persons is generally considered a contraindication. Current local immunization guidelines and prescribing information for individual vaccines should be consulted for further information.