Rebound exacerbation multiple sclerosis following cessation of oral treatment

BackgroundMultiple sclerosis (MS) management is changing, revolutionized by oral agents. Immune Reconstitution Inflammatory Syndrome (IRIS) describes exaggerated response to both exogenous (infective) and endogenous (non-infective) antigens.MethodsThis paper reports two cases of MS “rebound” following withdrawal of oral treatments.ResultsTwo patients, with suboptimal response to interferons, trialled oral MS treatment (fingolimod and BG12) with excellent response. Upon cessation both experienced MS “rebound” which responded to steroids.Conclusions“Rebound” may occur following withdrawal of oral MS therapies. Patients should be advised accordingly and possibly started on alternative treatment before the immunomodulating effect of therapy has subsided.