“It really does get into the question of, can we dichotomize our patients? We know there is a younger group and an older group, and we really wanted to look at if there was a difference in the drug working on one group or the other?”

The EXPAND study of siponimod in patients with secondary progressive multiple sclerosis (SPMS) validated the oral, second-generation sphingosine 1-phosphate (S1P) receptor modulator versus placebo. At the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) forum, February 27-29, 2020, in West Palm Beach, Florida, more data were presented from the assessment, the main findings of which showed siponimod had significantly reduced risk of 3-month and 6-month confirmed disability progression (CDP) by 21% and 26%, respectively.1

One of those datasets was presented by Le Hua, MD, director, Multiple Sclerosis Program, Cleveland Clinic Lou Ruvo Center for Brain Health. It evaluated the efficacy and safety of the therapy in patients under and over the age of 45 years at baseline. In total, the cohort consisted of 779 patients, of which 473 were ≥45 years old (siponimod, n = 213; placebo, n = 93) and 306 were <45 years old (siponimod, n = 303; placebo, n = 170).2

All told, those younger than 45 years experienced a reduced risk of 3 month CDP by 31.9% compared with placebo (hazard ratio [HR], 0.68; 95% CI, 0.45–1.04; P = .0734), and 6 month CDP risk by 39.5% (HR, 0.61; 95% CI, 0.38–0.96; P = .0339). Those 45 years and older reduced the risk of 3-month and 6-month CDP by 31.5% (HR,0.69; 95% CI, 0.48–0.97; P = .0340) and 33.1% (HR, 0.67; 95% CI, 0.45–1.0; P = .0471), respectively, versus placebo.

In a conversation with NeurologyLive, Hua discussed the findings of this subanalysis of the EXPAND study and what it ­­means for the understanding of older and younger groups of patients with MS.

For more coverage of ACTRIMS 2020, click here.
REFERENCES
1. Bar-Or A, Cohan SL, Coyle PK, Lublin FD, Meng X, Su W, Cree BA. Analysis of the effects of disease duration on the efficacy and safety of siponimod in patients with active SPMS from the Expand study. Presented at 2020 ACTRIMS Forum. February 27-29, 2020; West Palm Beach, FL. Abstract P030.
2. Hua L, Bar-Or A, Lublin FD, Meng X, Su W, Cree BA, Fox R. Analyses Of The Effect Of Baseline Age On The Efficacy And Safety Of Siponimod In Patients With Active SPMS From The Expand Study. Presented at 2020 ACTRIMS Forum. February 27-29, 2020; West Palm Beach, FL. Abstract P029.