American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the primary action of fingolimod in the treatment of multiple sclerosis?

1. To enhance lymphocyte migration

2. To restrict activated lymphocytes to lymph nodes

3. To block autoantibody production

4. To stimulate nerve regrowth

The correct answer is: To restrict activated lymphocytes to lymph nodes

Fingolimod primarily acts by modulating the movement of lymphocytes, particularly by restricting activated lymphocytes within the lymph nodes. This is achieved through its mechanism of action as a sphingosine-1-phosphate receptor modulator. By binding to these receptors, fingolimod prevents the egress of lymphocytes from the lymph nodes into the bloodstream and subsequently into the central nervous system (CNS). This retention of activated lymphocytes in the lymph nodes is important for treating multiple sclerosis, as it reduces the infiltration of these immune cells into the CNS, where they could contribute to demyelination and neurodegeneration. Therefore, this action helps to decrease the frequency of MS relapses and may protect against progressive disability. In contrast, while the other choices might seem relevant to autoimmunity or neuroprotection, they do not accurately describe fingolimod’s primary action in the context of MS treatment. Enhancing lymphocyte migration or stimulating nerve regrowth are not mechanisms associated with fingolimod, and blocking autoantibody production is not the direct action of this medication.