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Siponimod for treating secondary progressive multiple sclerosis

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1 Recommendations

1.1 Siponimod is not recommended, within its marketing authorisation, for treating secondary progressive multiple sclerosis with evidence of active disease (that is, relapses or imaging features of inflammatory activity) in adults.

1.2 This recommendation is not intended to affect treatment with siponimod that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS healthcare professional consider it appropriate to stop.

Why the committee made these recommendations

Interferon beta-1b is the only disease-modifying treatment available for people with active secondary progressive multiple sclerosis. However, few people take it. Most people do not have any disease-modifying treatment.

Clinical trial results show that siponimod reduces the number of relapses and slows disability progression compared with placebo. It is uncertain how effective siponimod is compared with interferon beta-1b because there is no evidence directly comparing them.

Because of the limited clinical evidence, the cost-effectiveness estimates are uncertain, and none of the analyses reflect the committee's preferred assumptions. Therefore, siponimod is not recommended.