Impact of a switch to fingolimod on depressive symptoms in patients with relapsing multiple sclerosis: An analysis from the EPOC (Evaluate Patient OutComes) trial

Samuel F. Hunter, Mark Agius, Deborah M. Miller, Gary Cutter, Luigi Barbato, Kevin McCague, Xiangyi Meng, Neetu Agashivala, Peter Chin, Eric Hollander

Research output: Contribution to journalArticle

10 Scopus citations


Background Depression is common in patients with multiple sclerosis (MS), may confound evaluation of therapeutic effectiveness and may be impacted by MS-specific treatments. Objective First, to assess the impact on depressive symptoms of a switch to fingolimod versus remaining on an injectable disease-modifying therapy (iDMT) in a post-hoc analysis of prospectively collected data from the EPOC study. Secondly, to investigate the underlying Beck Depression Inventory-II (BDI-II) factor structure in patients with MS, and estimate treatment differences using the resulting subscales. Methods EPOC was a 6-month, open-label study assessing patient-reported outcomes after switch from iDMT to oral fingolimod 0.5 mg versus remaining on iDMT in 1053 patients with relapsing-remitting MS. Results At end of study (EOS), a greater proportion of patients on fingolimod versus iDMT no longer had BDI-II scores indicating depression (p < 0.001). Fewer mildly and moderately symptomatic patients developed severe depressive symptoms, and fewer severely symptomatic patients continued to have scores indicating severe depression at EOS on fingolimod versus iDMT (p = 0.027, p = 0.038, p = 0.030, respectively). Two BDI-II subscales were identified and labelled Somatic and Affective; fingolimod demonstrated more reduction on both subscales at EOS versus iDMTs (p < 0.0001 and p = 0.0001, respectively). Conclusion A switch to fingolimod versus remaining on/switching to another iDMT was associated with an improvement in depressive symptoms in patients with relapsing-remitting MS.

Original languageEnglish (US)
Pages (from-to)190-198
Number of pages9
JournalJournal of the Neurological Sciences
StatePublished - Jun 15 2016



  • BDI-II
  • Depression
  • Fingolimod
  • Multiple sclerosis
  • Patient-reported outcomes
  • Satisfaction

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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