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Fingolimod is approved in England as second-line treatment for highly active relapsing-remitting multiple sclerosis (RRMS).To evaluate the real world effects of fingolimod in a typical NHS clinical setting (relevant to justify cost, risk of therapies like fingolimod and appropriate prescribing).Retrospective reviewing of medical records and MRI scans of RRMS patients on fingolimod for minimum 1 year at BSUH NHS Trust. Patient demographics, disease duration, Expanded Disability Status Scale (EDSS) and no evidence of disease activity (NEDA) were used as covariates. Findings were compared with FREEDOMS and TRANSFORMS outcomes.61 patients, followed-up for a mean of 2.7–years were included. The cohort was slightly older (mean age 43 vs. 36), included a higher proportion of females (85% vs. 65%–69%), had longer disease duration (12.5 vs 8) and was more disabled (median EDSS 4 vs 3) compared with trial data. At 1 year 81.35% were relapse-free, similar to trial data. For the whole follow-up period, NEDA was seen in 57.37% of patients, suggesting some expected waning effect. No patient covariates were found significant. 14.75% of patients discontinued treatment.Our data shows similar efficacy for fingolimod is possible within an NHS setting with comparable retention to clinical trials.