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Introduction <p>Sphingosine-1-phosphate (S1P) receptor modulators, regulating the S1P/S1PR pathway, lead to lymphocyte sequestration in lymphoid organs, which results in peripheral lymphopenia. This study evaluates the degree of lymphopenia induced by S1P modulators in people with Multiple Sclerosis (MS): Ozanimod, Siponimod, Ponesimod, and Fingolimod.</p> Methods <p>We conducted a retrospective multicenter study across thirteen MS centers in Italy, including 191 MS patients (mean age 46.4&#xa0;years; 61.3% women). Of these, 28.8% received Siponimod, 26.2% Ozanimod, 24.1% Fingolimod, and 20.9% Ponesimod. Lymphocyte counts were measured at baseline (T0), one month (T1), three months (T3), and six months (T6) post-treatment. Lymphopenia grades range from 0 (≥ 1.0 × 10^9 cells/L) to 4 (&lt; 0.2 × 10^9 cells/L), according to Common Terminology Criteria for Adverse Events.</p> Results <p>At T1, Ozanimod showed a significantly higher mean lymphocyte count than Siponimod and Fingolimod (p &lt; 0.001), Ponesimod higher mean lymphocyte count than Siponimod (p = 0.006). The differences persisted between Ozanimod than Siponimod and Fingolimod at T3 (p = 0.01 and p = 0.04), and between Ponesimod and Siponimod at T6 (p = 0.03). Severe lymphopenia cases were significantly higher in Siponimod than in Ponesimod and Ozanimod, at T1 (p = 0.001 and p = 0.0001). The differences remained significant between Ozanimod and Siponimod, at T3 (p = 0.001), and between Ponesimod and Siponimod, Fingolimod and Ozanimod, at T6 (p = 0.001). Grade 4 lymphopenia was observed in Ozanimod and Siponimod at T3.</p> Conclusion <p>This is the first real-world, head-to-head observational study comparing lymphopenia among different S1P modulators. Our results might assist in therapy choice depending on patients baseline hematological characteristics.</p>

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Real-world comparison of lymphopenia profiles in S1P receptor modulators for multiple sclerosis: a multicenter retrospective study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年8月6日

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  • Giorgia Teresa Maniscalco,
  • Maddalena Sparaco,
  • Maria Di Gregorio,
  • Giuseppina Cafasso,
  • Elisabetta Signoriello,
  • Felice Romano,
  • Rosa Iodice,
  • Roberta Fantozzi,
  • Paolo Bellantonio,
  • Aurora Zanghi,
  • Leonardo Sinisi,
  • Alessandro D’Ambrosio,
  • Vincenzo Busillo,
  • Valentina Scarano,
  • Rocco Capuano,
  • Luigi Lavorgna,
  • Michela Williams,
  • Antonio De Martino,
  • Maria Elena Di Battista,
  • Daniele Di Giulio Cesare,
  • Giacomo Lus,
  • Emanuele Cassano,
  • Paola Sofia Di Filippo,
  • Grazia Sibilia,
  • Gianmarco Abbadessa,
  • Vincenzo Andreone,
  • Simona Bonavita

摘要

Introduction

Sphingosine-1-phosphate (S1P) receptor modulators, regulating the S1P/S1PR pathway, lead to lymphocyte sequestration in lymphoid organs, which results in peripheral lymphopenia. This study evaluates the degree of lymphopenia induced by S1P modulators in people with Multiple Sclerosis (MS): Ozanimod, Siponimod, Ponesimod, and Fingolimod.

Methods

We conducted a retrospective multicenter study across thirteen MS centers in Italy, including 191 MS patients (mean age 46.4 years; 61.3% women). Of these, 28.8% received Siponimod, 26.2% Ozanimod, 24.1% Fingolimod, and 20.9% Ponesimod. Lymphocyte counts were measured at baseline (T0), one month (T1), three months (T3), and six months (T6) post-treatment. Lymphopenia grades range from 0 (≥ 1.0 × 10^9 cells/L) to 4 (< 0.2 × 10^9 cells/L), according to Common Terminology Criteria for Adverse Events.

Results

At T1, Ozanimod showed a significantly higher mean lymphocyte count than Siponimod and Fingolimod (p < 0.001), Ponesimod higher mean lymphocyte count than Siponimod (p = 0.006). The differences persisted between Ozanimod than Siponimod and Fingolimod at T3 (p = 0.01 and p = 0.04), and between Ponesimod and Siponimod at T6 (p = 0.03). Severe lymphopenia cases were significantly higher in Siponimod than in Ponesimod and Ozanimod, at T1 (p = 0.001 and p = 0.0001). The differences remained significant between Ozanimod and Siponimod, at T3 (p = 0.001), and between Ponesimod and Siponimod, Fingolimod and Ozanimod, at T6 (p = 0.001). Grade 4 lymphopenia was observed in Ozanimod and Siponimod at T3.

Conclusion

This is the first real-world, head-to-head observational study comparing lymphopenia among different S1P modulators. Our results might assist in therapy choice depending on patients baseline hematological characteristics.