Siponimod is a disease modifying therapy (DMT) for 'active' secondary progressive MS. Its brand name is Mayzent and you take it as a tablet.
Many people who were first diagnosed with relapsing remitting MS go on to develop secondary progressive MS years later. During this new, progressive stage of MS relapses become less common but a person’s disability carries on getting worse.
Siponimod might be suitable for some people with this kind of active secondary progressive MS.
- Who can take siponimod (Mayzent)?
- How does siponimod (Mayzent) work?
- How well does siponimod (Mayzent) work?
- What are the side effects of siponimod (Mayzent)?
- Siponimod (Mayzent) and pregnancy, breastfeeding and contraception
Across the UK you can have siponimod (Mayzent) if you've got active secondary progressive MS. Here ‘active’ means you’re still having relapses or MRI scans of your brain or spinal cord show new or growing lesions.
If you’ve been using a wheelchair for over six months, you won’t be offered a disease modifying therapy (DMT) like siponimod. This is because earlier drug trials seemed to show DMTs make no real difference to your MS if it’s affected your legs this much. New studies are looking at this again.
In England you can switch to siponimod if you have active secondary progressive MS and your MS is progressing (your disability is getting worse) even though you're already on a DMT. You don't need to wait for a relapse to happen or for new or growing lesions on your MRI scans.
This new eligibility was added in May 2022 to the NHS Blueteq system. That's what neurologists use to record how DMTs are used in England.
Your immune system makes special cells that attack and kill viruses and bacteria. In MS these cells attack your nerves by mistake.
Siponimod (Mayzent) targets two types of these cells called B and T cells. It traps them in your lymph nodes. This stops them getting into your brain and spinal cord where they would attack the myelin that covers your nerves. This stops inflammation and damage to the nerves.
You take siponimod as a tablet once a day. This is the first drug for secondary progressive MS that comes as a tablet. The only other drug for this type of MS (called beta interferon) must be injected.
Disability getting worse was slowed down by: 37% compared to placebo
This means that in the trial, on average, people whose secondary progressive MS was ‘active’ saw a 37% drop in the risk of their disability getting worse. This drop was compared to people who took a placebo.
Relapses dropped by: 46% compared to placebo
This means that in a major trial, on average, people whose secondary progressive MS was ‘active’ saw a 46% drop in the number of relapses they had. This was compared to people who took a placebo, a dummy pill with no drug in it.
People who took siponimod also:
- had fewer or smaller lesions on their brain scans
- had less risk of their memory and thinking getting worse. It either stayed the same, or, compared to people who took the placebo, it got worse but did so more slowly
- their brains didn’t shrink as fast. All brains shrink as we get older, but this happens faster in people with MS.
Compared to other DMTs, the risk of side effects, especially serious ones, doesn’t seem high.
In a major trial siponimod’s most serious side effects were:
- changes to how your heart beats. This includes a short-lived slowing down of your heart, especially when you first start the drug.
- a fall in the number of your white blood cells (lymphocytes). This might put you at more risk of infections. These are usually mild, like colds or urinary tract infections, but could be serious such as shingles.
- macular oedema. This is a swelling in the back of your eye that can affect your sight. One in 50 people in the trial got this
- about one in 50 people had a seizure.
In the trial among the most common side effects (more than one in ten people had them) were:
- high blood pressure
- higher than normal levels of liver enzymes
We don’t have research on whether siponimod can harm unborn babies. But we know it can cause this kind of damage in animals. So if you can get pregnant, you need a negative pregnancy test result before starting this treatment. You must avoid getting pregnant while taking siponimod – and, if you decide to stop taking it, for 10 days after your final dose.
If you and your partner want to have a child, discuss this with your neurologist. If you think you’ve become pregnant, let your medical team know at once. Never stop your DMT without first getting their advice.
Studies in animals show siponimod (Mayzent) can get into breast milk. So you shouldn’t feed your baby this way while on this drug.
If you can get pregnant, you must use reliable contraception (the ‘pill’, condom, an implant or IUD) while you’re on siponimod (Mayzent). If you decide to stop taking this drug, you should keep using contraception for 10 days week after your final dose.
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