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New eligibility criteria for siponimod (Mayzent) for MS on the NHS in England  

Criteria for prescribing siponimod (Mayzent) for MS on the NHS in England have changed. We look at the reasons why, and what that means for our community.

Siponimod (Mayzent) is an oral disease modifying therapy (DMT) licensed for people living with active secondary progressive MS. The NHS in England have updated their eligibility criteria meaning more people could be eligible to take it.

The new access criteria only apply in England. In Scotland, Wales, and Northern Ireland, the criteria stay as they were.

What do siponimod (Mayzent) changes mean for people with MS?

Siponimod is licensed for people with active secondary progressive MS. Until now it’s only been available if active MS shows up as relapses or on MRI scans (as new or growing lesions).

Now in England it's also available if you’ve been taking another DMT which you were prescribed when you had relapsing MS, and your neurologist sees signs your MS is progressing.

Here, progression of your MS is defined by a change in your expanded disability status scale (EDSS) score. Specifically, a one point increase in your EDSS score if it was less than six to begin with, or a half point increase if your score was six to begin with.

Why are siponimod (Mayzent) eligibility criteria changing? 

Secondary progressive MS is a stage of MS which comes after relapsing MS for many people. With this type of MS your disability gets steadily worse.  

Sometimes, secondary progressive MS can be hard to diagnose. And it can be hard to define the transition point between relapsing MS, and secondary progressive MS. To get this diagnosis you must have had relapses in the past, and now your disability has been getting steadily worse for at least six months. Things getting worse mustn't be linked to any relapse you've had.

Because these changes often happen slowly, people who develop secondary progressive MS may still be taking a DMT they were given for relapsing MS. However, the DMT may be masking the signs of active secondary progressive MS (new lesions on MRI or new relapses) that could have qualified them to take siponimod. 

Now, under these new criteria, access to siponimod has been expanded to these people whose MS has progressed during treatment with another DMT, even though that DMT may be suppressing their overall disease activity.

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