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Rituxan or Siponimod for SPMS

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    Rituxan or Siponimod for SPMS

    I have been taking Rituxan for 3.5 years and am now wondering if Siponimod would be more effective at slowing progression of future disability. I realize this is an unanswerable question, but welcome perspective. Marco?

    Hi caldred:

    Rituxan seems to work well for RRMS. But when tested in PPMS, it was found to be no more effective overall than placebo. Since SPMS is also also more degenerative than inflammatory, it wouldn't be surprising if Rituxan isn't that helpful for SPMS, either. (I have RRMS and it didn't do anything for me.)

    Sure, siponimod might be more effective, but it isn't commercially available yet. And there are a couple of things to bear in mind: 1) the level of adverse events in the phase 2 trial for RRMS was quite high, even for the lowest trial dose, so that will undoubtedly carry over to any dose for SPMS, and 2) the SPMS trial measured a disability endpoint after only 3 months, so it remains to be seen how well it actually works over the long term.