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Electrocardiographic assessments and cardiac events after fingolimod first dose a comprehensive monitoring study

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Item Type:Article
Title:Electrocardiographic assessments and cardiac events after fingolimod first dose a comprehensive monitoring study
Creators Name:Limmroth, V. and Ziemssen, T. and Lang, M. and Richter, S. and Wagner, B. and Haas, J. and Schmidt, S. and Gerbershagen, K. and Lassek, C. and Klotz, L. and Hoffmann, O. and Albert, C. and Schuh, K. and Baier-Ebert, M. and Wendt, G. and Schieb, H. and Hoyer, S. and Dechend, R. and Haverkamp, W.
Abstract:BACKGROUND: First dose observation for cardiac effects is required for fingolimod, but recommendations on the extent vary. This study aims to assess cardiac safety of fingolimod first dose. Individual bradyarrhythmic episodes were evaluated to assess the relevance of continuous electrocardiogram (ECG) monitoring. METHODS: START is an ongoing open-label, multi-center study. At the time of analysis 3951 patients were enrolled. The primary endpoints are the incidence of bradycardia (heart rate < 45 bpm) and second-/third-degree AV blocks during treatment initiation. The relevance of Holter was assessed by matching ECG findings with the occurrence of clinical symptoms as well as by rigorous analysis of AV blocks with regard to the duration of pauses and the minimal heart rate recorded during AV block. RESULTS: Thirty-one patients (0.8%) developed bradycardia (<45 bpm), 62 patients (1.6%) had second-degree Mobitz I and/or 2:1 AV blocks with a lowest reading (i.e. mean of ten consecutive beats) of 35 bpm and the longest pause lasting for 2.6 s. No Mobitz II or third-degree AV blocks were observed. Only one patient complained about mild chest discomfort and fatigue. After 1 week, there was no second-/third-degree AV block. CONCLUSIONS: Continuous Holter ECG monitoring in this large real-life cohort revealed that bradycardia and AV conduction abnormalities were rare, transient and benign. No further unexpected abnormalities were detected. The data presented here give an indication that continuous Holter ECG monitoring does not add clinically relevant value to patients' safety.
Keywords:Fingolimod, First Dose, Electrocardiogram, Cardiac Effects, Bradycardia, Atrioventricular Conduction
Source:BMC Neurology
ISSN:1471-2377
Publisher:BioMed Central (U.K.)
Volume:17
Number:1
Page Range:11
Date:18 January 2017
Additional Information:Triall registration: NCT01585298 ; registered April 23, 2012.
Official Publication:https://doi.org/10.1186/s12883-016-0789-7
PubMed:View item in PubMed

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