There seems to be a lower risk of rebound syndrome during the first year after switching from fingolimod to rituximab compared to switching from fingolimod to cladribine in patients with multiple sclerosis (MS), according to a new study published in Multiple Sclerosis and Related Disorders. This finding suggests that switching from fingolimod to rituximab may lead to better initial clinical outcomes.

To compare the risk of rebound after switching from fingolimod to cladribine or rituximab in patients with MS, a team of researchers led by Elisabeth Gulowsen Celius, MD, PhD, conducted a retrospective cohort study using data collected prospectively from 2 hospitals that use different treatment strategies.

The researchers identified 73 patients with MS who switched from fingolimod. Of these, 33 switched to cladribine while 40 switched to rituximab. All patients were followed up for at least 6 months after the switch.

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The results showed that 7 (21.1%) of the patients switching from fingolimod to cladribine had rebound syndrome while none of those switching to rituximab had a rebound. Similarly, 10 patients (30.3%) who switched to cladribine had a relapse while only 5 (12.5%) of those who switched to rituximab had a relapse.

In terms of magnetic resonance imaging (MRI) disease activity, more than half (54.5%) of those who switched to cladribine (a total of 18 patients) showed this while this percentage was 20% for patients who switched to rituximab (a total of 8 patients).

“Younger age and previous high relapse rate were associated with increased risk of rebound in the cladribine group,” the researchers also said.

Rebound syndrome or rebound disease activity is defined as a sudden onset of extensive disease activity. This can include severe clinical relapse and extensive brain or spinal MRI lesions. Rebound syndrome is often seen after fingolimod withdrawal in patients with MS.


Nygaard GO, Torgauten H, Skattebøl L, et al. Risk of fingolimod rebound after switching to cladribine or rituximab in multiple sclerosis. Mult Scler Relat Disord. Published online April 17, 2022. doi:10.1016/j.msard.2022.103812