Siponimod selectively modulates sphinogosine 1-phosphate (S1P) receptors S1P1 and S1P5. It reduces egress of lymphocytes from lymphoid tissues and prevents recirculation of peripheral lymphocites to the CNS. It crosses the blood-brain barrier and it may prevent synaptic degeneration and it may promote remyelination. Dr. Wilner discusses the implications of a recent double-blind, randomized phase 3 study on siponimod in secondary progressive multiple sclerosis (SPMS).1 5 important facts:
1. Siponimod is a new sphinogosine 1-phosphate that is more selective than fingolimod.
2. In the current study siponimod decreased progression of disability and T2 lesion volume increase in a population of secondary progressive MS.
3. Clinical effects were modest.
4. Siponimod has similar adverse effects to fingolimod
5. Neither fingolimod or simponimod are FDA approved for SPMS.
1. Kappos L1, Bar-Or A2, Cree BAC, et al. Siponimod versus placebo in secondary progressive multiple sclerosis (EXPAND): a double-blind, randomised, phase 3 study. Lancet. 2018;391:1263-1273.