From the Research
Dimethyltryptamine (DMT) is not a recommended treatment for Secondary Progressive Multiple Sclerosis (SPMS) as there is no evidence to support its efficacy in treating this condition. The most recent and highest quality study, 1, suggests that disease-modifying therapies (DMTs) such as siponimod, ocrelizumab, and ofatumumab are effective in reducing disability progression in SPMS.
Treatment Options for SPMS
- Siponimod (Mayzent) is specifically approved for active SPMS and has been shown to reduce disability progression in this population 1.
- Ocrelizumab (Ocrevus) and ofatumumab (Kesimpta) are also approved for RMS, including active SPMS, although the evidence for their efficacy in SPMS is based on post hoc analyses of small subgroups 1.
- Interferon beta preparations, natalizumab, and mitoxantrone are other options, but their use is limited by concerns about efficacy and safety in SPMS 2, 3, 4.
Key Considerations
- Treatment selection should be individualized based on the patient's disease activity, disability level, comorbidities, and preferences.
- Regular monitoring for disease progression and medication side effects is essential, with MRI scans typically performed annually.
- Early treatment is crucial as DMTs are most effective when started before significant disability accumulates, though benefits may be more modest in SPMS compared to relapsing forms of MS 1.
Current State of Research
- The pathogenesis of SPMS is poorly understood, and the specific role of inflammation in disease progression is not well defined 4.
- Recent natural history studies suggest that disease progression occurs regardless of the presence of superimposed relapses, but poor recovery from clinical relapses does account for the acquisition of disability 4.
- Further research is needed to identify effective treatments for SPMS and to understand the underlying mechanisms of disease progression.