A few days ago we had access to this alert in Medscape. An MS patient, that had completed the 6-hour vigilance period after the first dose of fingolimod, died unexpectedly the next day. We don’t know much about it and we should wait until this case is resolved and an official report released. We only know that the patient was already taking beta-blockers and calcium channel antagonists, with bradycardia among their side effects. However, it re-inforces my view that Fingolimod safety has to be carefully followed-up. Anyway, one important message is that an oral treatment, a pill, does not necessarily have to be safer than a biological treatment. It may be easier to take for patients but not necessarily innocuous.