Drug Siponimod Improves Thinking Speed in Multiple Sclerosis

When patients with advanced form of multiple sclerosis called secondary progressive multiple sclerosis were given the drug siponimod for one to two years, improvement in cognitive processing speed was observed. The study was published in the journal Neurology, the medical journal of American Academy of Neurology.

Multiple sclerosis (MS) is neurodegenerative which affects the person’s thinking skills.

Multiple sclerosis is one of the most common demyelinating disease and is commonly seen in high income countries.

Cognitive processing speed is the amount of time taken by a person to take in information, process it, and then react to complete a task. It can affect different aspects of daily life including driving skills, social activities, and employment.

Most of the patients are initially diagnosed with relapsing-remitting multiple sclerosis in which there are flare-ups of symptom followed by periods of remission. Eventually these patients transition to secondary progressive multiple sclerosis in which there is steady, slow, worsening of the disease.

Currently, in the US, no drugs are approved for the treatment of cognitive impairment in multiple sclerosis. However, according to this study, siponimod, which is prescribed to slow the progression of physical disability, can also be used to improve cognitive processing speed in patients with advanced multiple sclerosis.

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The Clinical Trial

The study included 1,651 patients with secondary progressive multiple sclerosis having an average age of 48. The patients were followed for up to two years. Out of this group, two-thirds of the patients were given two milligrams of siponimod per day and one third of the patients were given a placebo.

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The patients were evaluated by using cognitive tests at the start of the study and again after every six months. The Symbol Digit Modalities Test that measures cognitive processing speed is sensitive and reliable test in multiple sclerosis studies.

When compared to the patients taking placebo whose scored remained constant, patients taking siponimod showed improvement in scores every six months.

Results of Trial

An increase or decrease of four or more points is said to be clinically significant and is associated with quality of life outcomes and disability progression.

The results showed that

• 35 percent of the patients taking siponimod improved their scores by four or more points compared to 27 percent of patients taking placebo
• 41 percent of the patients taking siponimod showed no change as compared to 42 percent of the patients raking placebo
• 25 percent of the patients taking siponimod had lower scores by four or more points as compared to 32 percent patients taking placebo

Author of the study Ralph H.B. Benedict PhD, University of Buffalo in New York and member of the American Academy of Neurology said, “We are impressed to see that siponimod may improve cognitive processing speed in people with MS. However more research is needed to confirm our results. Because we did not see changes on two other cognitive tests, more research should further examine how siponimod affects scores on a broader array of thinking and memory tests. This research is needed before prescribing siponimod for cognition can be considered.

Side effects which occurred more frequently in patients taking siponimod were high blood pressure, eye swelling, shingles, higher levels of liver enzymes, and convulsions.

The limitation of the study was that the researchers did not collect information on education or multiple sclerosis symptoms like fatigue and depression which has an influence on the scores of the Symbol Digit Modalities Test. This can affect the impact of siponimod on cognition.

Source-Medindia