Multiple Sclerosis is not a single pathological entity but rather two abnormal processes that advance in parallel yet inter-connected tracks and varying degrees of severity, which results in different clinical presentations. In the beginning the infiltrative inflammation predominates in the brain and spinal cord with the clinical imprimatur of relapses and remissions. Patients, who are usually young, have the illusion that once the inflammation process subsides, they would be disease-free for a long time.
However, a more sinister and crippling process has already started: degeneration. The clinical picture consists of progression with limiting sequelae like chronic pain and spasticity of upper and lower limbs. The available drugs targeted the first process but failed to address the second one. Until a new drug was studied: siponimod. Like fingolimod, it is a modulator of sphingoside-1-phosphate (SIP) receptors but it only selectively modulates types 1 and 5 receptors of the lymphoid tissue; the first one promotes the disposal of lymphocytes while the second one is stored in the CNS.
Kapos et al. collected more than 1600 patients from almost 300 clinical centers in the USA and Europe to study the administration of 2 mg of sipominod per day to half the cohort to compare it to the other half that only received a placebo for a median period of eighteen months. The principal studied index was “time to three-month confirmed disease progression” (CPD), which was defined as a 1.0 point increase in expanded Disability Status Scale (EDSS) score for the participants with moderate disability or 0.5 point increase for those with severe disability initially.
Only 26% of participants receiving siponimod had grave, prolonged disability compared to 32% of those receiving only the placebo; the drug had a hazard ration of 0.79 and a relative reduction of 21% of the risk to develop crippling symptoms. Once the study was finished all the participants were offered the chance to take it. Imaging studies showed a reduction from baseline in T2 lesion volume and the gadolinium-enhancing lesions. Moreover, those participants taking the drug had less decline in the brain volume between the 12th and 14th months compared to placebo.
Investigators are moderately optimistic about these results, but they point out that, in order to prevent the serious disabilities this disease provokes in young people, they must strive to intervene earlier in progressive forms of MS. Much, much earlier.
What do you think? Please tell us.
Don’t leave me alone.
“Good morning Mario and thanks for this great article. I really appreciate that you are always looking for new therapies for the MS patients. Keep up the effort as many physicians do not even really care about being updated any more, alienated as they are due to the financial pressures on their practices.”
I will be honest, this is the first time I have heard about this drug. I have been on Gilenya for a while now and it honestly is working, I think! I know the injection types did not work for me before, but that was because I was not doing them like I was supposed to. I was on Gilenya for 6 years and made the decision to try something different last year. It was a bad choice because I had a terrible relapse. Now no one can say my relapse was because of the medication change or stress, but I ended up back on Gilenya. I am scared to try anything else now. I do feel that my MS has progressed, but the doctors do not listen. They do want me to do another MRI, but those are so expensive. I have had MS for almost 18 years and they just told me about a program that is offered for MRI co-pay assistance. I have NO idea what took them so long to share this with me, but hopefully it will work out. I don’t know if I want the MRI to show the same as it was in October or there to be improvements or show more lesions to explain all my pain and spaticity. Part of me just does not really want to know. I think I would rather avoid the reality.
“Oh, please forgive me for not politely congratulating you on your two years of blogging. Please send me the link to the right page.
A kiss. Ta-ta.”
Good morning dear Alyssa and thanks for your nice commentary. I took the liberty of editing a little bit for social graces’ sake. I hope you don’t mind as I do it to my friends (ask Bojana) all the time. You should connect more with MS support groups and spaces like mine because you might be a good candidate to participate in a clinical trial for some of the new drugs in the pipeline. What do you have to lose? Un grosso baccione. Arrivederci!
https://drmolaplume.com/2018/05/07/the-hand-of-god/
Good morning Dr. Sahib:
You have been rendering a Yeoman’s service for the patients and in the process making other like me aware of new cure. God may bestow you new avenues for doing still more for the humanity.
WITH REGARDS
HARBANS
Good morning my dear friend Il Chiaro and thanks for your nice commentary. As a physician, I am duty-bound to help patients and their families to seek cure or at least alleviation. And bringing information about new treatments is of paramount importance for our empowered patients. A big hug. Arrivederci!
Good morning Dr. Sahib.
Your commentary on research on use of medicines and bringing the same to the purview of the general public, and for ensuring curing various disease is laudable.
I again appreciate this.
A BIG HUG TO YOU AS WELL
Wiith regards
HARBANS
Good morning and thanks for your nice and undeserved compliment my dear spiritual friend across the oceans. Sorry for the delay in answering but my son came yesterday back to Miami after spending 6 months in Argentina and I was all day long with him. A big hug. Arrivederci!
Good morning Dr. Sahib.
It is not the time which counts but the feelings which is attached with it which counts more than anything else Your commentary is just touching to my heart. My son along with my daughter-in-law and my grand-son have returned from UK and I too was playing with my grad son.
WITH KIND REGARDS
HARBANS
The more research, the better. Hopefully, one day….
Good day, dottore.
Good morning and thanks for your nice commentary, my dear Bo. Yes, the more medical research, the better for all of us. Un baccione. A posto.
Good morning to you a hopefully sunny morning it is. This drug has been on my radar for some time. I took Gilyenia the companies drug for relapsing remitting MS for years. They were the first oral drug for MS. However, it’s shown so far very “fair” outcomes. 26% less disability compared to 32% with a placebo isn’t a very large jump. For people, like me, who have been in secondary progressive MS stages for years, we were hoping for something better to come along. This might help some of the newer diagnosed but unfortunately doesn’t add much hope to the rest of us who have been praying for a good secondary progressive MS drug.
Good morning and thanks for this nice commentary, dear Jamie (with a sunny greeting included) It seems that you are well versed in all the new possibilities of MS therapy, as you should be. Yes, it is a small step but it’s in the right direction. I know there are other potential drugs in the pipeline of some companies but I do not want to comment on these until they reach at least the stage of the phase III or IV of clinical trials. Keep up your strong faith, girl. Un baccione. Arrivederci!