“Another way their selectivity may help is that in patients with comorbidities—pre-existing heart disease, for example—we may feel somewhat more comfortable using these medications.”
While the approval of fingolimod (Gilenya; Novartis) almost a decade ago was welcomed as the first of its class for multiple sclerosis (MS), further research identified the need for more selective sphingosine-1-phosphate (S1P) modulators due to adverse event (AE) monitoring needs associated with fingolimod. Since its approval, 2 more agents—siponimod (Mayzent; Novartis) and ozanimod (Zeposia; Bristol Myers Squibb)—have entered the market and another—ponesimod (Janssen)—is currently before the FDA for review.

One such advantage that these more selective agents offer is that they allow for easier use in patients with comorbidities, which can encompass a large percentage of the MS patient population. Jeffrey Cohen, MD, director, Mellen Center for MS Treatment and Research, Cleveland Clinic, noted that additionally, while it is not clear if there are advantages in improving symptoms associated with MS, such as fatigue, it does seem that these agents do not worsen them.

In an interview with NeurologyLive, Cohen explained how often these oral agents are turned to in the treatment of patients with MS, as well as what benefits these selective S1P modulators offer clinicians who utilize them as first- or second-line therapies.