Progression to Wheelchair in Secondary Progressive Multiple Sclerosis and Impact of Siponimod: Post Hoc Analyses From...

Delaying time to requiring a wheelchair in people living with MS is an important treatment goal to maintain quality of life and guard against increased healthcare costs. In this post hoc analysis, the effects of siponimod versus placebo on time to sustained Expanded Disability Status Scale (EDSS) ≥ 7.0 over the core part of the Phase 3 EXPAND study were assessed.

The time to sustained EDSS ≥ 7.0 (time to requiring a wheelchair) was analysed for participants with secondary progressive multiple sclerosis (SPMS). Analyses were based on a While on Treatment (WOT) set that censored participants if entering open-label treatment. Subgroup analyses were conducted in participants with active versus non-active SPMS (defined based on pre-study/baseline criteria), and in participants with baseline EDSS 6.5.

In the overall EXPAND population, siponimod reduced the risk of reaching sustained EDSS ≥ 7.0 (requiring a wheelchair) by 40% (hazard ratio [HR], 0.60; 95% confidence interval [CI], 0.41-0.88; p = 0.009) versus placebo; the reduction in risk was 51% (HR, 0.49; 95% CI, 0.29-0.81; p = 0.005) versus placebo in participants with active SPMS and 22% (HR, 0.78; 95% CI, 0.42-1.45; p = 0.437) in non-active SPMS.

Siponimod reduced the risk of requiring a wheelchair in participants with SPMS versus participants receiving placebo, with a greater effect in those with active disease. Time to requiring a wheelchair is a highly relevant treatment goal and an important indicator of treatment effect in patients with SPMS.