Siponimod-associated cystoid macular edema without known risk factors

Purpose: This case report highlights the importance of monitoring ocular health for patients starting on siponimod treatment, a sphingosine-1-phosphate receptor modulator, for relapsing-remitting multiple sclerosis. By showing how medication adverse events present in patients, we can revisit the cur...

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Main Authors: Min Young Kim, Anas Alkhabaz, MBBS, Stephen J. Smith, M.D., Yaping Joyce Liao, M.D., Ph.D.
Format: Article
Language:English
Published: Elsevier 2024-12-01
Series:American Journal of Ophthalmology Case Reports
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Online Access:http://www.sciencedirect.com/science/article/pii/S2451993624001348
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author Min Young Kim
Anas Alkhabaz, MBBS
Stephen J. Smith, M.D.
Yaping Joyce Liao, M.D., Ph.D.
author_facet Min Young Kim
Anas Alkhabaz, MBBS
Stephen J. Smith, M.D.
Yaping Joyce Liao, M.D., Ph.D.
author_sort Min Young Kim
collection DOAJ
description Purpose: This case report highlights the importance of monitoring ocular health for patients starting on siponimod treatment, a sphingosine-1-phosphate receptor modulator, for relapsing-remitting multiple sclerosis. By showing how medication adverse events present in patients, we can revisit the current guidelines on ophthalmic evaluation recommendations. Observations: We report a 60-year-old patient who presented with unilateral blurry vision upon initiating siponimod therapy for the treatment of relapsing-remitting multiple sclerosis. Her exam findings did not show visual field defects but were significant for cystoid macular edema distorting the foveal contour. Upon stopping siponimod therapy, the patient's macular edema and symptoms resolved significantly within 7 days and completely resolved 1 month later. Conclusions and importance: This case showcases siponimod-associated cystoid macular edema in a patient without known risk factors, such as diabetes mellitus and uveitis. The patient also had the earliest reported symptom onset to date following the initiation of siponimod therapy. Current recommendations from the American Academy of Ophthalmology and FDA stress the importance of ophthalmic evaluation three to four months after treatment initiation for patients with a history of risk factors. Given our current case and its comparison with four previously reported cases, we recommend that physicians inform patients of possible ocular adverse events with siponimod therapy regardless of their past medical history and duration of treatment.
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spelling doaj-art-44623265d4ff4607a9b0be615476646a2024-12-18T08:50:29ZengElsevierAmerican Journal of Ophthalmology Case Reports2451-99362024-12-0136102124Siponimod-associated cystoid macular edema without known risk factorsMin Young Kim0Anas Alkhabaz, MBBS1Stephen J. Smith, M.D.2Yaping Joyce Liao, M.D., Ph.D.3Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA; Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USAByers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USAByers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USAByers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA; Corresponding author. Byers Eye Institute, Department of Ophthalmology, Stanford University, School of Medicine, 2452 Watson Court, Palo Alto, CA, 94303-5252, USAPurpose: This case report highlights the importance of monitoring ocular health for patients starting on siponimod treatment, a sphingosine-1-phosphate receptor modulator, for relapsing-remitting multiple sclerosis. By showing how medication adverse events present in patients, we can revisit the current guidelines on ophthalmic evaluation recommendations. Observations: We report a 60-year-old patient who presented with unilateral blurry vision upon initiating siponimod therapy for the treatment of relapsing-remitting multiple sclerosis. Her exam findings did not show visual field defects but were significant for cystoid macular edema distorting the foveal contour. Upon stopping siponimod therapy, the patient's macular edema and symptoms resolved significantly within 7 days and completely resolved 1 month later. Conclusions and importance: This case showcases siponimod-associated cystoid macular edema in a patient without known risk factors, such as diabetes mellitus and uveitis. The patient also had the earliest reported symptom onset to date following the initiation of siponimod therapy. Current recommendations from the American Academy of Ophthalmology and FDA stress the importance of ophthalmic evaluation three to four months after treatment initiation for patients with a history of risk factors. Given our current case and its comparison with four previously reported cases, we recommend that physicians inform patients of possible ocular adverse events with siponimod therapy regardless of their past medical history and duration of treatment.http://www.sciencedirect.com/science/article/pii/S2451993624001348Cystoid macular edemaSiponimodCMEFingolimodAdverse eventS1P
spellingShingle Min Young Kim
Anas Alkhabaz, MBBS
Stephen J. Smith, M.D.
Yaping Joyce Liao, M.D., Ph.D.
Siponimod-associated cystoid macular edema without known risk factors
American Journal of Ophthalmology Case Reports
Cystoid macular edema
Siponimod
CME
Fingolimod
Adverse event
S1P
title Siponimod-associated cystoid macular edema without known risk factors
title_full Siponimod-associated cystoid macular edema without known risk factors
title_fullStr Siponimod-associated cystoid macular edema without known risk factors
title_full_unstemmed Siponimod-associated cystoid macular edema without known risk factors
title_short Siponimod-associated cystoid macular edema without known risk factors
title_sort siponimod associated cystoid macular edema without known risk factors
topic Cystoid macular edema
Siponimod
CME
Fingolimod
Adverse event
S1P
url http://www.sciencedirect.com/science/article/pii/S2451993624001348
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AT yapingjoyceliaomdphd siponimodassociatedcystoidmacularedemawithoutknownriskfactors