Tagsiponimod

Fingolimod vs. Siponimod

Barts-MS rose-tinted-odometer: ★★ (mid-week sepia = #704214) In my post on rebound disease activity in a person with secondary progressive MS switching from fingolimod to siponimod, someone asked whether there is any logic in switching DMTs within the class of S1P modulators. Two or three years ago I would have said no, but now I would say yes. There are well defined and clear differences between...

Be careful when switching from Fingolimod to Siponimod

Barts-MS rose-tinted-odometer: zero-★s (purple Sunday) The following case suggests a horizontal switch from fingolimod to siponimod may not be the wisest thing to do. This patient developed severe fingolimod rebound despite switching to siponimod without a washout. As you know fingolimod works on 4 out of 5 of S1P receptors (S1P1, 3, 4, and 5). In comparison, siponimod works on S1P1 and S1P5 only...

An ethical quandary

Barts-MS rose-tinted-odometer: ★★ The two case studies below are creating an ethical quandary in my MS practice. Can you help me please? Case 1The first is the 40-year old woman with MS who is NEDA-2 (no evident disease activity) on DMF (Tecfidera) with no documented relapses in the last 4 years and a series of annual MRI scans with no new or enlarging T2 MS lesions. However, there has been a...

Stuck in a loop

Starting certain MS drugs may get you stuck in a loop that you never bargained for when you started them in your early thirties or forties. The ability to stop taking drugs at an older age is something we more or less take for granted, especially if we have been disease free for ‘X’ many years. However, in the MS world things are never that simple or straightforward; there is...

Please help I am getting worse

Barts-MS rose-tinted-odometer: ★ After my clinic last week I was emotionally drained and probably more than usual. Patient after patient was telling me the same story and asking the same questions. “Since lockdown last year things have gotten worse, what can I do about it?” My superficial interpretation is that most of these patients had gotten worse because of relative physical and...

Swiss Neurologists Challenge Lublin

Barts-MS rose-tinted-odometer: ★ I have just been chastised by someone from a Swiss Pharma company for suggesting that siponimod is a cul-de-sac DMT. Why can’t someone who is diagnosed and labelled as having SPMS who is started on siponimod be switched to any other DMT? I agree, but the absurdity of the situation arises because of the rigidity of the Lublin classification of MS (see below) and...

The forgotten many: not any more

Most of you will have heard by now that NICE has green-lighted siponimod for the treatment of active secondary progressive multiple sclerosis on the NHS. As the UK member of the EXPAND trial steering committee, Novartis who market the drug asked me for a quote, which sums up my opinion about the news. “The NICE approval of siponimod to treat secondary progressive multiple sclerosis with active...

NICE & Siponimod

Here we go again. Most readers will have gathered by now that NICE has not recommended Siponimod for treating active SPMS under the NHS. This is a big disappointment for the MS community in the UK particularly for those patients who have active SPMS or worsening SPMS on a DMT who were hoping to be switched to Siponimod.  It is clear that some of the assumptions NICE have made about the treatment...

The Hopebird is singing

Today the EU licensed siponimod for the treatment of active secondary progressive MS. It has been a very long and winding road to get here. Siponimod is not an eagle, phoenix or maven, but rather a hopebird which symbolises the importance of “an optimistic approach to what lies ahead”. Less than a decade ago we were telling our patients with a progressive course that they were beyond hope, that...

Is siponimod the first cul-de-sac DMT?

Barts-MS rose-tinted-odometer  ★ A big worry for neurologists and pwMS is the sequencing of DMTs. What DMTs can be used before and after each other and does the sequencing of DMTs change the risk profile of the individual DMTs concerned? These have been dealt with many times on this blog and I am in the final stages of completing phase 1 of my app that will address the specific issues around each...

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