Part 2

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Part 1 of this article examined how the definitions of secondary-progressive and primary-progressive MS (SPMS, PPMS) have evolved and the contentious role that focal inflammatory activity has played (See Secondary-progressive MS: conceptual and practical challenges, NeuroSens, April 17, 2019). One shift has been to view the phenotypes of SPMS and PPMS as virtually indistinguishable with respect to their pathophysiology and clinical course, so both SPMS and PPMS trials will be considered here. Read More

Ponesimod (ACT-128800) met most of its endpoints in the phase III OPTIMUM trial versus teriflunomide in patients with MS, according to a preliminary announcement. Ponesimod is the latest in a series of sphingosine-1-phosphate receptor drugs, a group that includes fingolimod, siponimod and ozanimod. Somewhat unique is that ponesimod is selective to S1PR-1 and acts as an agonist rather than an antagonist (or functional agonist). Ponesimod has a short half-life (30 hours) and is eliminated in about 1 week (Dash et al. Xenobiotica 2018;48:442-451). The drug was developed by Actelion and will be marketed by Janssen, both of which are owned by Johnson & Johnson. Read More

“Therapeutic inertia” is a term coined over a decade ago to describe the 90% of clinicians who failed to intensify antihypertensive therapy in patients with high blood pressure (Antrade et al. Am J Manag Care 2004l;10(7 Pt 2):481-486). The concept was first applied to multiple sclerosis treatment decision-making three years ago and has become something of a cottage industry ever since, with about a dozen papers and abstracts to date on the topic. Read More