Siponimod Treatment for Secondary Progressive MS: Neurologist Expectations

Doctor reading medical chart
Doctor reading medical chart
Investigators hypothesize siponimod will function as an alternative therapeutic choice to monoclonal antibodies in MS.

The following article is part of conference coverage from the 2019 Annual Meeting of the Consortium of Multiple Sclerosis Centers, in Seattle, Washington. Neurology Advisor‘s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from CMSC 2019.

SEATTLE — Prelaunch, neurologists believed that siponimod – a sphingosine-1-phosphate receptor modulator and the first disease-modifying therapy (DMT) with a broad secondary progressive multiple sclerosis (MS) label in the United States – would displace the oral DMTs; however, investigators hypothesize the agent will function as an alternative therapeutic choice to monoclonal antibodies, according to research presented at the Consortium of Multiple Sclerosis Centers’ Annual Meeting, held May 28 to June 1, in Seattle, Washington.

This study used quarterly online MS survey responses from US neurologists from the August 2018 (n=99) and May 2019 (n=~100) surveys to compare neurologists’ prelaunch expectations with early launch siponimod perceptions and self-reported prescribing patterns.

Six months before siponimod launch, 13% of US neurologists anticipated prescribing siponimod immediately postlaunch, with a significantly smaller candidate pool within the not-active secondary progressive MS patient segment (15%) compared with the active secondary progressive MS patient segment (28%; P <.05), but similar to relapsing-remitting MS (13%).

Unaided, neurologists identified the following characteristics of patients they saw as benefiting most from siponimod: relapsing MS (17%), DMT refractory (20%), active/worsening (21%), and secondary progressive MS (33%). Willingness to prescribe was highest for relapsing-remitting MS transitioning to secondary progressive multiple sclerosis based on confirmation of relapse-related disability accumulation (mean: 5.52 on a 10-point scale), secondary progressive MS with clinical or radiologic evidence of inflammatory activity (5.42), and relapsing-remitting MS transitioning to secondary progressive MS based on confirmation of relapse-independent disability accumulation (5.30). Only 23% assumed siponimod will displace ocrelizumab, and were more likely to believe it will displace dimethyl fumarate (39%) or fingolimod (59%). A lack of first-dose observation requirement would substantially increase the willingness of 55% of neurologists to use siponimod.

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Study investigators conclude, “US neurologists anticipate gradual siponimod uptake concentrated in the transitioning [relapsing-remitting multiple sclerosis] and active [secondary progressive multiple sclerosis] segments among patients with disability progression and evidence of ongoing acute inflammatory disease activity for whom multiple previous DMTs have been ineffective. Unlike neurologists’ prelaunch perceptions that siponimod will displace the oral DMTs, we hypothesize that siponimod will offer an alternative therapeutic choice to the monoclonal antibodies due to the dominant share of the class among recently switched active [secondary progressive multiple sclerosis] patients.”

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Schobel VR, Robinson J. Evaluating early-launch siponimod uptake for the treatment of secondary progressive multiple sclerosis against prelaunch expectations among US neurologists. Presented at: The Consortium of Multiple Sclerosis Centers Annual Meeting; May 28-June 1, 2019; Seattle, WA. Abstract DXT03