Abstract
Multiple sclerosis (MS) is a chronic inflammatory autoimmune and neurodegenerative disease of the central nervous system that mainly affects young adults. MS therapy has made significant progress in recent years.
The secondary progressive form of MS (SP-RS) is the second most common form of MS worldwide. However, capturing conversion to secondary progression is very difficult in clinical practice due to large interindividual differences during the course of the disease and also due to the absence of accurate diagnostic tools and validated biomarkers.
For this reason, the diagnosis of SP-MS is often made retrospectively and delayed by about three years. While there are several approved disease-modifying drugs available for relapsing-remitting MS, an effective drug for SP-MS has long been lacking.
Siponimod, a selective sphingosine-1-phosphate receptor modulator, is the first oral drug approved for the treatment of SP-RS that has been shown to slow clinically confirmed progression. The efficacy and safety of siponimod were tested in a phase IIIEXPAND clinical study.
Siponimod is indicated in adult patients with SP-MS with evidence of disease activity, ie with evidence of relapse and / or inflammatory activity as evidenced by imaging. The patient must be tested for CYP2C9 before treatment with siponimod.