Ponisimod: The Preferred Choice for MS Treatment Among US Clinicians

The average clinician in the United States who treats patients with multiple sclerosis (MS) is expected to select ponesimod over siponimod, fingolimod, or ozanimod, according to study results presented at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2023, held in San Diego, California, from February 23 to 25.

In patients with MS, sphingosine-1-phosphate (S1P) receptor modulators are thought to have similar benefit-risk and safety profiles, but require different clinical management considerations both prior to and during use. Although this may impact treatment convenience and burden, their influence on clinician preferences has not yet been described. For the study, researchers assessed the influence of clinical management considerations on preferences among clinicians who treat MS with S1P receptor modulators.

The researchers conducted a multi-criteria decision analysis (MCDA) among S1P receptor modulators used for the treatment of patients with MS. This was weighted by preference data obtained in a discrete choice experiment (DCE) in which US clinicians selected among hypothetical, unlabeled therapies that were characterized by attributes with different levels of performance.

Study inclusion required all participating clinicians to have treated 5 or more patients with MS in the past year. Attributes, which were chosen based on expert clinical advice, included the following:

• Number of drug-drug interactions
• First-dose observations
• Immune system recovery time
• Interactions with foods high in tyramine
• Genotyping
• Liver function tests
• Eye examinations
• Interactions with antidepressants

To establish partial utilities and relative attribute importance for each attribute, researchers relied on mixed-logit model. To assess the estimated percentage of clinicians who would choose one treatment over another, they used predicted choice probabilities (PCPs). Using MCDA, researchers determined the value composition for MS treatment alternatives (ie, ponesimod, siponimod, fingolimod, and ozanimod). Here, they gauged how well the treatments performed in each attribute using partial utilities attained in the DCE.

A total of 200 clinicians completed the DCE. The researchers found that the most important driver of clinician preferences were drug-drug interactions (RAI=26%), followed by first-dose observations (RAI=16.0%), and immune system recovery time (RAI=15.8%).

Clinicians significantly preferred ponesimod (PCP=53.8%) over siponimod (PCP=26.9%), fingolimod (PCP=16.6%), and ozanimod (PCP=2.9%) to treat their patients. Ponesimod had the highest overall value score (4.78) as well, which was followed by siponimod (4.10), fingolimod (3.61), and ozanimod (1.88).

“When clinical management considerations are considered, the average US clinician treating MS is expected to choose ponesimod over siponimod, fingolimod, or ozanimod,” the researchers concluded.