…2018; abstract 322). Another area of interest is modulation of sphingosine-1-phosphate (S1P) signalling in the CNS, which has been implicated in astrocyte activation and astrogliosis (Sorensen et al. Mol Pharmacol 2003;64:1199-1209). Functional antagonism of S1P1 blocks lymphocyte egress from lymphoid tissue and is presumed to be the principal mode of action of fingolimod in MS. However, preclinical studies have reported that the efficacy of fing…

Siponimod (Mayzent), a second-generation sphingosine-1-phosphate (S1P) receptor modulator, has received approval by the U.S. Food and Drug Administration for the treatment of relapsing forms of multiple sclerosis, including clinically isolated syndrome (CIS), relapsing-remitting MS and active secondary-progressive MS (SPMS). The estimated prevalence of SPMS in the U.S. is 37.1 per 100,000 population (Khurana et al. AAN 2018; abstract P2.380), or…

…reporting use of 5 or more medications (Frahm et al. Sci Rep 2019;9:3743; free full text at www.ncbi.nlm.nih.gov/pmc/articles/PMC6403326/pdf/41598_2019_Article_40283.pdf). Most patients were currently taking a disease-modifying therapy (DMT) for MS. Other medications commonly used were gastrointestinal drugs, thrombosis prophylaxis drugs, osteoporosis drugs, antihypertensives and sedatives. The study population (n=306) comprised patients with CIS…

…l. JAMA 2019;321:175-187). The results indicate that starting with a higher-efficacy disease-modifying therapy (DMT) or switching earlier can substantially reduce the risk of SPMS. The propensity score-matched cohort study included data from 1555 patients (mean age 35 years at baseline) treated at 68 neurology centres in the period 1988-2017. All patients had a minimum of four years of follow-up. Starting treatment with a front-line DMT (glatirame…