From the FDA Drug Label
MAYZENT is indicated for the treatment of relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults. MAYZENT is a sphingosine 1-phosphate (S1P) receptor modulator indicated for the treatment of relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults.
The treatment option for Secondary Progressive Multiple Sclerosis (SPMS) is siponimod (PO), specifically for active secondary progressive disease 1, 1, 1.
- Key points:
- Siponimod is indicated for the treatment of relapsing forms of MS, including active secondary progressive disease.
- It is a sphingosine 1-phosphate (S1P) receptor modulator.
- The recommended maintenance dosage is 2 mg, with adjustments for certain genotypes or concomitant medications.
From the Research
Secondary progressive multiple sclerosis (SPMS) treatment should prioritize siponimod (Mayzent) as the first-line disease-modifying therapy, given its proven efficacy in reducing disability progression and inflammation, as demonstrated in the EXPAND trial 2. The treatment of SPMS focuses on slowing disability progression and managing symptoms.
- Disease-modifying therapies approved specifically for SPMS include siponimod, which reduces inflammation and may protect nerves by preventing immune cells from reaching the brain.
- Ocrelizumab, which targets B cells involved in the immune response, may also be considered, although its efficacy in SPMS is less established compared to siponimod.
- Interferon beta medications like Betaseron and Rebif, which help regulate immune function, may be used in some cases, but their efficacy in SPMS is limited.
- Mitoxantrone may be used in some cases but has significant side effects, including heart damage. Treatment also includes symptom management for issues like:
- Spasticity (using baclofen or tizanidine)
- Fatigue (amantadine or modafinil)
- Pain (gabapentin or pregabalin)
- Bladder dysfunction (oxybutynin) Physical therapy, occupational therapy, and cognitive rehabilitation are essential components of comprehensive care. SPMS is indicated when a patient with relapsing-remitting MS begins to experience steady neurological decline with or without superimposed relapses, representing a transition to a more progressive disease course with increasing disability. Treatment decisions should be individualized based on disease activity, disability progression rate, and potential medication side effects, with siponimod being the preferred option due to its superior efficacy and safety profile, as demonstrated in recent studies 3, 4.