Fingolimod sphingosine kinase is metabolized to the active metabolite fingolimodfosfata.At nanomolar concentrations fingolimodfosfat associated with SIP-receptors 1, 3 and 4 on the surface of lymphocytes and types rapidly penetrate trenbolone acetate kits into the central nervous system (CNS) through the blood-brain barrier, binding to SIP-receptors 1, 3 and 5 on the surface of neuronal types. Communicating with the SIP-lymphocyte receptors, blocks the ability of lymphocytes fingolimodfosfat leave the lymph nodes, which leads to a redistribution of lymphocytes in the body. Thus there is no reduction of the total number of lymphocytes in the body.
Redistribution of lymphocytes leads to a decrease lymphocytic infiltration of the central nervous system, reduce the severity of inflammation and the degree of nerve tissue damage.
With regular use of the drug decline in the number of lymphocytes maintained. Since the majority of T and B lymphocytes continuously pass through lymphoid organs influence fingolimod expressed on these cells to the greatest extent. However, about 15-20% of T lymphocytes, which are cells of the immune effector memory and plays an important role in peripheral immune surveillance, do not pass through lymphoid organs and are not affected by fingolimod.
Within a few days after stopping the drug in the blood marked increase in the number of lymphocytes. Normalization of the number of lymphocytes occurs in 1-2 months following cessation of treatment.Constant reception fingolimod results in a slight decrease in neutrophil count to approximately 80% from baseline. Monocytes are not affected by fingolimod.
In applying the drug in patients with relapsing-remitting multiple sclerosis (average score on a scale of disability by EDSS 2.0) fingolimod 0.5 mg reduced the incidence of clinical manifestations of the disease by 54%. Before the drug in 70% of patients had stable remission for 2 years (compared to 45.6% in the placebo group). Fingolimod significantly reduced the risk of disability progression, significantly increased the time before the 3-month and 6-month period confirmed disability progression (assessed as an increase on the EDSS scale assessment from baseline) compared to placebo. The results of magnetic resonance imaging (MRI) of the brain in patients with relapsing-remitting multiple sclerosis during treatment with fingolimod confirm a significant reduction in disease activity flow (intensity of the inflammatory process in the central nervous system, the size and number of foci of demyelination).
Absorption of fingolimod is slow (time to maximum plasma concentration, t max12-16 hours). The absolute oral bioavailability is 93%. Equilibrium concentration in the blood plasma is reached within 1-2 months of regular treatment (1 per day). The equilibrium concentration of fingolimod is about 10 times higher than the concentration after the first dose. After multiple dose 0.5 mg 1 time per day and the concentration of fingolimod fingolimodfosfata increased, probably proportional to dose. FFingolimod largely distributed in the body tissues (volume of distribution of about (1200 ± 260) liters). Fingolimod penetrates into the brain, which was shown in a clinical study in healthy volunteers. In a study in 13 volunteers remitting multiple sclerosis, received in equilibrium fingolimod 0.5 mg, fingolimod number (or fingolimodfosfata) appeared in the semen of 10,000 times lower than the initial dose (0.5 mg). Metabolism biotransformation fingolimod in humans occurs through phosphorylation stereoselective feedback to the pharmacologically active (S) -enantiomer fingolimodfosfata and by oxidative biotransformation through isoenzyme cytochrome CYP4F, preferably CYP4F2, and the subsequent decay like bold acids to inactive metabolites, as well as by the formation of a pharmacologically inactive nonpolar ceramide analogues fingolimod. after single oral fingolimod inside fingolimod-related major components in the blood within 34 days after administration, are fingolimod . After trenbolone acetate kits oral administration, 81% of the dose is slowly excreted in the urine as inactive metabolites. Fingolimod and fingolimodfosfat not appear intact in urine but are the major components of the drug metabolites in the feces, where each number is <2.5% of the dose. After 34 days the excretion of the administered dose is 89%. The characteristics in selected groups of patients. The pharmacokinetics of fingolimod and fingolimodfosfata not differ in males and females, in patients of different ethnic origin. Patients with impaired severe renal function leads to AUC increase by 34 and 14% for fingolimod and fingolimodfosfata, respectively. Fingolimod should be used with caution in patients with mild and moderate hepatic impairment: while AUC fingolimod increased by 12 and 44%, respectively. In patients with moderate and severe hepatic impairment (classes B and C on the Child-Pugh) half-life of the drug is increased by approximately 50%. The mechanism of excretion and results of studies of population pharmacokinetics suggest that dose adjustment is required for elderly patients. Caution is advised to use the drug trenbolone acetate kits in patients over the age of 65 years due to limited clinical experience. Pharmacokinetics in children and adolescents under the age of 18 years have not been studied.
These patients may be defined as “not responding” for a full, properly assigned to therapy (in the general case – not less than one year of treatment), one type of therapy, modifying the course of disease. Patients should be present for at least 1 relapse in the previous year while on therapy, and at least 9 T2-lesions defined according to MRI of the brain, or at least 1 lesion, accumulating gadolinium. “Not the answer” can also be defined as patients with unchanged or increasing the frequency of relapses, or ongoing severe relapses, as compared to the previous year.
Patients with rapidly evolving, severe relapsing-remitting multiple sclerosis, defined as having 2 or more disabling relapses within one year, or the presence of one or more lesions accumulating gadolinium for MRI of the brain or a significant increase in lesion T2 lesions on MRI, compared with the data of the previous MRI.
fingolimod assigned to decrease the frequency of clinical exacerbations of disease and reduce disability progression risk .
- immunodeficiency syndrome.
- An increased risk of opportunistic infections, including immunocompromised patients receiving immunosuppressive therapy currently or in the past.
- The active phase of severe infections, chronic infections (hepatitis, tuberculosis).
- Revealed malignancy in an active phase, with the exception of basal cell skin cancer.
- Severe liver damage (class C Child-Pugh).
- Hypersensitivity to fingolimod or any other component of the formulation.
Efficacy and safety of the drug trenbolone acetate kits in children and adolescents under the age of 18 years have not been established.
Use during pregnancy and during breastfeeding
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