Novartis have confirmed that an MS’ers died after starting fingolimod. It was an unexplained sudden death. This suggests it was probably due to off-target effects of fingolimod on the cardiovascular system. You may be aware that MS’ers taking fingolimod typically have a drop in heart rate after the first dose and rarely can develop a block in the conduction of electrical impulses in the heart. MS’ers have to start taking fingolimod in hospital and have their heart rate and cardiac conduction monitored for at least 6 hours. Whether this death will change the current practice will depend on us having more details about this case. At the moment we have to assume this is a very rare event (less than 1 in 10,000 MS’ers starting fingolimod).