Disease modifying therapy in secondary progressive MS

The goal of disease modifying therapy in secondary progressive multiple sclerosis is to delay the progression of disability.

Interferon-beta1b has been shown in one randomised double blind placebo controlled multicentre trial to significantly increase the time to confirmed neurological deterioration.

Interferon-beta1b is licensed in Europe for secondary progressive MS.

NICE state (1,2):

• Interferon beta-1b (Extavia) is recommended as an option for treating multiple sclerosis, only if:
  • the person has relapsing-remitting multiple sclerosis and has had 2 or more relapses within the last 2 years or
  • the person has secondary progressive multiple sclerosis with continuing relapses and the company provides it according to the commercial arrangement
    
    
• Siponimod is recommended, within its marketing authorisation, as an option for treating secondary progressive multiple sclerosis with evidence of active disease (that is, relapses or imaging features of inflammatory activity) in adults
  • recommended only if the company provides siponimod according to the commercial arrangement

Notes:

• Siponimod is a second-generation sphingosine-1-phosphate (S1P) receptor modulator - study evidence suggests that siponimod may prevent synaptic neurodegeneration and promote remyelination in the CNS

Reference:

• NICE (June 2018). Beta interferons and glatiramer acetate for treating multiple sclerosis
• NICE (November 2020). Siponimod for treating secondary progressive multiple sclerosis
• Gentile A, Musella A, Bullitta S, et al. Siponimod (BAF312) prevents synaptic neurodegeneration in experimental multiple sclerosis. J Neuroinflammation 2016;13:207