Mayzent® (siponimod) will be a new oral treatment for secondary progressive multiple sclerosis (MS) in adults.
About 50% of patients with relapsing-remitting MS will progress to secondary progressive MS within 10 years.
Mayzent® is an immune modulator that helps prevent white blood cells from entering the CNS and damaging it.
But don’t expect big improvements with it.
For every 19 patients treated with Mayzent® for up to 3 years, 1 will have a modest delay in progression of physical disability compared to placebo.
Recommend saving Mayzent for those with secondary progressive MS and evidence of active inflammation, such as a new brain lesion on an MRI, despite other meds (interferon beta, etc).
Anticipate private payers to require a prior authorization, since Mayzent® will be costly…about $2,700 per month.
Expect the dose of Mayzent® to be titrated up over 5 days to reduce the risk of slowed heart rate…then given once daily.
Watch for cytochrome P450 interactions. Mayzent® is metabolized by CYP2C9 and CYP3A4. Avoid combining it with meds that inhibit or induce these enzymes, such as fluconazole or rifampin.
Be aware of side effects and many monitoring recommendations.
For example, counsel patients starting Mayzent® that they may feel dizzy or tired due to slowed heart rate. But explain this should improve within a couple of weeks.
Caution using with meds that lower heart rate (beta-blockers, etc)…and switch the interacting med to another class if possible.
Recommend checking liver enzymes before starting Mayzent® and about 3 months after starting…then periodically.
Explain it’s okay to give inactivated vaccines (injectable flu, etc) to stable patients…but give live vaccines (Zostavax II, etc) at least one month BEFORE starting Mayzent®.
If switching to Mayzent®, consider the half-life of the MS med being stopped…to avoid additive immunosuppressant effects.
For example, it’s okay to start Mayzent® immediately after stopping interferon beta-1a (Avonex, Rebif). But consider a washout of up to 12 weeks after stopping natalizumab (Tysabri).