Few options are available for patients whose relapsing remitting multiple sclerosis has transitioned to secondary progressive multiple sclerosis (SPMS). Many patients remain on the therapies they began when they had the RRMS form of the disease or switch to another treatment approved for RRMS or mitoxantrone. Recent research suggests a new immunomodulator could give these patients another alternative.
An international team of researchers will present results of the EXPAND study on October 26 at the 2017 European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) annual meeting in Paris (abstract 129).
MRI. (Source: Getty Images)
The EXPAND trial, which enrolled 1,651 participants in 31 countries, is the largest randomized, controlled study of patients with SPMS to date. Previously published results showed a slowing of disability progression for patients who received siponimod based on clinical assessments compared to placebo. Siponimod is a immunomodulator of sphingosine 1-phosphate receptor subtypes 1 and 5. The current analysis supports these findings with imaging showing significant reduction in the size and number of brain lesions versus placebo.
The investigators had access to post-baseline imaging for more than 80% of study. Compared to those who received the placebo, patients treated with siponimod experienced a reduction in T2 lesion volume of 613 mm3 at 12 months and 778 mm3 at 24 months. Siponimod also reduced the number of T1 gadolinium-enhancing (Gd+) lesions 86.6% in the first year and 80.6% by year 2 compared to placebo. The mean number of T2 lesions that appeared or enlarged was also 80.6% lower. The drug also slowed the loss of brain volume.