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SPMS – Siponimod for Active SPMS — SCE Neurology MCQ

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ModerateMultiple Sclerosis & CNS InflammationSPMS – Siponimod for Active SPMSSCE Neurology

A 50-year-old woman with MS asks whether there is evidence for disease modification in secondary progressive MS (SPMS). Her EDSS is 6.0 and she has had no relapses for 3 years but continues to progress. What DMT options exist for SPMS?

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Correct answer: A — Siponimod is approved for active SPMS (with evidence of inflammatory activity — relapses or MRI activity within the preceding 2 years); ocrelizumab may also have benefit in active SPMS. There is currently no approved DMT for non-active SPMS

Treatment options for SPMS depend on whether the disease is 'active' (ongoing relapses or inflammatory MRI activity) or 'non-active' (progressive disability accumulation without inflammatory activity). Siponimod (NICE TA656) is specifically approved for active SPMS based on the EXPAND trial. Ocrelizumab may benefit younger SPMS patients with inflammatory activity. For non-active SPMS, no DMT has convincingly shown benefit — rehabilitation, symptom management, and supportive care are the mainstays. A: Options exist for active SPMS. C: Most RRMS DMTs do not work in SPMS. D: Steroids do not slow progression. E: Interferon beta showed minimal benefit in SPMS trials.

Reference: NICE TA656 Siponimod; EXPAND Trial; NICE NG100