Multiple Sclerosis Society of Canada

Siponimod

Overview:

  • Also known as: BAF312 (Novartis Pharmaceuticals AG)
  • Route of Administration: Oral, once daily
  • Type: sphingosine-1-phosphate receptor modulator; immunomodulator
  • Emerging treatment for: Relapsing-remitting MS and secondary progressive MS
  • Status: In Phase III of clinical trials for SPMS

Belonging to the same class of drugs as fingolimod (Gilenya), siponimod is under study to evaluate its effectiveness in reducing the number of inflammatory brain lesions in people living with relapsing-remitting MS. Siponimod is also being evaluated as an experimental treatment for relapsing remitting MS.

How it Works

Siponimod works by entering the central nervous system (CNS) and binding to specific subtypes of the sphingosine 1-phosphate (S1P) receptor. The S1P receptor is found on the surface of specific immune cells called T cells and B cells that play a role in causing damage to the CNS in MS. By binding to the S1P receptor, siponimod prevents these harmful immune cells – specifically B cells and both CD4+ and CD8+ T cells – from being activated and released from the lymph nodes and thymus gland into the blood circulation and, hence, the brain and spinal cord.

Research and Results

Several early studies in animals demonstrated the siponimod reduces the number of white blood cells in the blood circulation. These were complemented by a study in mice with an MS-like disease showing that administration of siponimod suppressed disease activity and neurological deficits.

The safety, tolerability and efficacy of siponimod in participants with secondary progressive MS is being explored in the EXPAND study, a phase III, multicenter, randomized, double-blind, parallel group, placebo-controlled clinical trial. The trial included 1,651 people with secondary progressive MS from 31 countries; participants were randomized to receive either 2 mg of siponimod (given daily after gradually increasing the dose over 6 days at doses of 0.25, 0.25, 0.5, 0.75, 1.25, and 2 mg) or a dummy drug ( placebo) in a 2:1 ratio, respectively.

Preliminary results shared in a press release from Novartis showed that the trial met its primary endpoint of significantly reducing disability progression as measured by sustained changes in the expanded disability status scale (EDSS) score, versus placebo. Further details of the trial will be presented at the 32 nd Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), September 17th, in London, UK. The MS Society will provide details as they become available.

Adverse Effects Reported

In the phase II study for relapsing-remitting MS, the most common adverse effects that were reported include headache, slowing of heart rate, dizziness, and nose and throat infections.

References

Gergely P, et al. The selective sphingosine 1-phosphate receptor modulator BAF312 redirects lymphocyte distribution and has species-specific effects on heart rate. Br J Pharmacol. 2012; 167(5):1035-47.

Kappos L, et al. Siponimod (BAF312) for the Treatment of Secondary Progressive Multiple Sclerosis: Design of the Phase 3 EXPAND Trial. Neurology (Meeting Abstracts), 12 Feb 2013.

Kappos L, et al. Siponimod (BAF312) for the treatment of secondary progressive multiple sclerosis: Design of the phase 3 EXPAND trial. Mult Scler Relat Disord. 2014; 3(6):752.

Lewis ND, et al. Circulating monocytes are reduced by sphingosine-1-phosphate receptor modulators independently of S1P3. J Immunol. 2013; 190(7):3533-40.

Selmaj K, et al. Siponimod for patients with relapsing-remitting multiple sclerosis (BOLD): an adaptive, dose-ranging, randomised, phase 2 study. Lancet Neurol. 2013; 12(8):756-67.