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Neurological conditions

Siponimod now recommended for patients with secondary progressive MS

The National Institute for Health and Care Excellence’s independent appraisal committee was satisfied that siponimod would be a cost-effective option for the NHS.

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The updated draft guidance comes after the National Institute for Health and Care Excellence initially rejected the use of siponimod for secondary progressive multiple sclerosis in June 2020, over uncertainty around its effectiveness

Updated draft guidance from the National Institute for Health and Care Excellence (NICE) has recommended siponimod (Mayzent; Novartis) for the treatment of secondary progressive multiple sclerosis (MS).

This comes within days of the Scottish Medicines Consortium accepting siponimod as a treatment for people with secondary progressive MS.

In June 2020, NICE issued draft guidance for public consultation which did not recommend siponimod for the treatment of secondary progressive MS.

It said this was because there was uncertainty as to how effective siponimod was compared with interferon beta-1b, which is currently the only disease-modifying treatment available for people with active secondary progressive MS.

The independent appraisal committee requested further cost-effectiveness analyses to be included in the company’s economic model, which has since been provided. These analyses included comparing siponimod with best supportive care and assuming that there is a reduction in the treatment effect of siponimod over time.

As a result, when taking into consideration the confidential commercial arrangement agreed with NHS England and NHS Improvement to make siponimod available at a discounted price, NICE’s independent appraisal committee was satisfied that the drug was likely to represent a cost-effective use of NHS resources.

Olivia Moswela, lead neurosciences and neuro-critical care pharmacist at Oxford University Hospitals NHS Foundation Trust, said the decision was a “positive step” for people with multiple sclerosis.

“Up to now, treatment options for people with active secondary progressive MS were limited to interferon beta injections,” she explained. 

“Historically, disease-modifying therapies were restricted to the relapsing-remitting form of multiple sclerosis [but] are now available across the spectrum of disease, including progressive multiple sclerosis.

“In recent years, there has been an increase in the complexity of disease-modifying therapies and monitoring/pharmacovigilence requirements, coupled with an increase in the numbers of people on multiple sclerosis disease-modifying therapies. 

Moswela said this development provided an opportunity for pharmacists to become part of multiple sclerosis multidisciplinary teams and use their expertise to optimise the care of people with MS.

Nick Moberly, chief executive of the MS Society, said the recommendation was “a huge step forward in the treatment for people living with secondary progressive MS (SPMS) in England and Wales”.

“More than 130,000 people live with MS in the UK, and while people living with the relapsing form have over a dozen treatment options available to them, until now, those with active SPMS had only one – and it wasn’t suitable for everyone.”

“Siponimod will offer hope to thousands of people, and we’ll be making sure everyone who could benefit from it will be able to access it.”

John Stewart, NHS director of specialised commissioning at NHS England, said that the new deal provided patients “with treatment hope for the first time in a decade”.

“The NHS, in collaboration with NICE and working closely with Novartis, has secured another landmark deal which will help up to 11,000 people with secondary progressive multiple sclerosis lead healthier and better-quality lives.”

If no appeals are received, NICE expects to publish final guidance in November 2020.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2020.20208450

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