Mayzent and Neupro: Indications for Use
Mayzent (siponimod) is used to treat relapsing forms of multiple sclerosis, while Neupro (rotigotine) is used to treat Parkinson's disease and restless legs syndrome.
Mayzent (Siponimod)
- Mayzent is FDA-approved for the treatment of relapsing forms of multiple sclerosis, including clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease in adults 1
- As a selective sphingosine 1-phosphate receptor (S1PR) modulator, Mayzent targets S1PR1 and S1PR5 receptors, reducing clinical and MRI-defined outcomes of disease activity and disability progression 2
- Siponimod has demonstrated efficacy in reducing 3-month confirmed disability progression on the Expanded Disability Status Scale (EDSS) in patients with secondary progressive multiple sclerosis 2
- The beneficial effects of siponimod appear to be sustained during up to 5 years of treatment in clinical studies 2
Neupro (Rotigotine)
- Neupro is indicated for the treatment of Parkinson's disease and restless legs syndrome (RLS) 3, 4
- The American Academy of Sleep Medicine suggests against the standard use of transdermal rotigotine for RLS treatment due to concerns about adverse effects with long-term use, particularly augmentation 5, 6
- For Parkinson's disease, Neupro can be used as monotherapy in early-stage disease or as an adjunct to levodopa across all disease stages 7
- Rotigotine is a non-ergoline dopamine agonist with highest affinity for dopamine D3 receptors, followed by D2, D4, D5, and D1 receptors 8
Administration and Pharmacokinetics
- Mayzent requires CYP2C9 genotype testing before initiation, as patients with CYP2C9*3/*3 genotype should not take the medication 1
- Neupro is administered via a transdermal patch that delivers the drug continuously over 24 hours, providing stable steady-state plasma concentrations 3
- The transdermal delivery system of rotigotine offers advantages for patients with gastrointestinal disturbances that reduce the suitability of oral medication 7
Safety Considerations
- Mayzent may cause serious side effects including slow heart rate (bradycardia), infections, progressive multifocal leukoencephalopathy (PML), and macular edema 1
- Neupro's safety profile includes adverse events typical of dopaminergic stimulation and transdermal patch application 7
- For RLS treatment, alpha-2-delta ligands (gabapentin, gabapentin enacarbil, or pregabalin) are recommended as first-line therapy over dopamine agonists like rotigotine due to lower risk of augmentation 6
Special Populations
- Mayzent should be used with caution in patients with certain cardiac conditions, and is contraindicated in those who have had a heart attack, unstable angina, stroke, TIA, or certain types of heart failure in the last 6 months 1
- For patients with RLS and end-stage renal disease, gabapentin is suggested over dopamine agonists like rotigotine 5, 6
Remember that treatment decisions should be based on the specific form of disease, disease severity, comorbidities, and patient preferences, with careful monitoring for potential adverse effects.