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Siponimod

Phase 4FDA approved

Multiple Sclerosis | Small molecule | Neurology |Novartis AG|Trials Updated: Jun 20, 2024

Siponimod development status

FDA approval on record Mar 26, 2019 as Mayzent
Approval holderNovartis
ApplicationNDA209884
Highest phase Phase 4 (NCT04792567)
Phase scored for NVSPhase 3
Registered trials 18 across 3 sponsors since Apr 2009

Label indication MAYZENT is indicated for the treatment of relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults. MAYZENT is a sphingosine 1-phosphate (S1P) receptor modulator indicated for the treatment of relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and… FDA label

Siponimod target and mechanism

Molecular targetS1PR1
Target classAgonist
ModalitySmall molecule

Also known as BAF312, BAF312 solution, BAF312 tablet

Success Probability

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Market & Valuation

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Trial Design

UNCONTROLLED
Total Trials7
Total Enrollment2,406

FDA Designations

No designations recorded

Siponimod clinical trials

Siponimod · 7 trials · 10 indications

Phase 3 2Phase 2 3Phase 1 2
NCT03623243Safety and Tolerability of Conversion From Oral, Injectable, or Infusion Disease Modifying Therapies to Dose-titrated Oral Siponimod (Mayzent) in Advancing RMS PatientsMultiple Sclerosis
COMPLETED185 Analytics
NCT01665144Exploring the Efficacy and Safety of Siponimod in Patients With Secondary Progressive Multiple Sclerosis (EXPAND)Secondary Progressive Multiple Sclerosis
COMPLETED1,651 Analytics
PHASE3COMPLETED
Safety and Tolerability of Conversion From Oral, Injectable, or Infusion Disease Modifying Therapies to Dose-titrated Oral Siponimod (Mayzent) in Advancing RMS Patients
Multiple SclerosisUnlock trial analytics
PHASE3COMPLETED
Exploring the Efficacy and Safety of Siponimod in Patients With Secondary Progressive Multiple Sclerosis (EXPAND)
Secondary Progressive Multiple SclerosisUnlock trial analytics

Study Endpoints

Primary Endpoints

Number of Participants With at Least One Treatment-emergent Adverse Event (TEAE) Related to Study Drug During the Treatment Period
From first dose of study drug up to 30 days after last dose of study drug (up to 7 months)

An Adverse Event (AE) is any untoward medical occurrence in a participant that does not necessarily have a causal relationship with the treatment. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding, for example), symptom, or disease temporarily associated with the use of a medicinal product, whether or not considered related to the medicinal product. TEAEs are defined as the AEs started after the first dose of siponimod to 30 days after the date of the last actual administration, or events present prior to start of treatment but which increased in severity. TEAEs suspected to be related to study drug are reported.

Percentage of Participants With 3-month Confirmed Disability Progression (CDP) Events as Measured by the Expanded Disability Status Scale (EDSS)
Baseline, every 3 month up to the maximum of approximately 3 years

The EDSS uses an ordinal scale to assess neurologic impairment in MS based on a neurological examination. Scores in each of 7 functional systems (Visual, Brain Stem, Pyramidal, Cerebellar, Sensory, Bowel \& Bladder, and Cerebral) and an ambulation score were combined to determine the EDSS steps, ranging from 0 (normal) to 10 (death due to MS). 3-month confirmed disability progression is defined as an increase of score of 1 point in patients with baseline score of 3.0 to 5.0 and 0.5 point increase with baseline score of 5.5 to 6.5 sustained for at least 3 months.

Absolute Perihematoma Edema (aPHE) Volume Measured by Computed Tomography (CT) Scan After Intracerebral Hemorrhage (ICH)
On Day 14 following ICH

Following the initial diagnostic CT, repeat CT images were obtained between 24-48 h after the diagnostic scan, and on Day 7 and Day 14 to capture the trajectory of PHE increase and plateau after ICH. Only non-contrast study CT scans were obtained on Day 7 and Day 14. The non-contrast scan acquired on each patient at first follow-up (i.e. 24-48 h after the diagnostic scan) served as the baseline for our analysis. All CT scans were uploaded through a secure server, and edema and hematoma volumes were measured in a semi-automated manner by one Central Reader.

Total Number of Adverse Events During Evaluation of Long Term Safety and Tolerability of BAF312A in Extension Study.
Baseline up to approximately 5 years

Refer to adverse events for complete listing of serious adverse events and other adverse events. Adverse events of interest were presented in separate tables. There were no reports of macular edema.

Number of Participants With Cardiac Conduction Abnormalities During the Titration Phase of the Study (Without Washout)
Baseline Extension up to day 10

Number of patients with abnormal ECG conduction findings during dose-blinded titration at any visit post-dose, by type of abnormality and treatment (Extension Set). Number analyzed represent participants who had ECG results. Washout was defined as not being on treatment drug between Core and Extension for \>7 days. Abbreviation: Con=conduction, IVCD=intraventricular conduction defect , WPW=Wolff-Parkinson-White syndrome

Number of Participants With Cardiac Conduction-IVCD Abnormality During the Titration Phase of the Study (With Washout)
Baseline Extension up to day 10

Number of patients with abnormal ECG conduction findings during dose-blinded titration at any visit post-dose, by type of abnormality and treatment (Extension Set). Number analyzed represent participants who had ECG results. Washout was defined as not being on treatment drug between Core and Extension for \>7 days. Abbreviations: washout = WO, Con=conduction

Number of Participants With Changes in Blood Pressure for Overall Extension Study. (Extension Analysis Set)
Baseline Extension up to approximately 5 years

Sitting blood pressure was measured in triplicate. The categories of notably low and high values and changes are presented for systolic (SBP) and diastolic (DBP). Multiple occurrences for a patient are counted as one occurrence in this table.

Number of Participants With Viral Infections of Interest Greater or Equal to 5% in Any Dose Group (Extension Set)
Baseline Extension up to approximately 5 years

Most infections were clinical diagnoses and were not confirmed by microbiology / virologic investigations. A patient with multiple occurrences of an infection for a preferred term is counted only once in each specific category. Events identified as infections by the Investigator and defined as an AE with onset on or after the first dose of Extension Study drug up to and including 30 days after the date of the last dose

Number of Participants With Dermatologic Alterations - Basal Cell Carcinoma (Extension Set)
Baseline Extension up to approximately 5 years
Dose Responsiveness of BAF312 Based on the Number of Combined Unique Active MRI Lesions (CUAL)
3 months of treatment

Combined unique active lesions (CUAL) were defined as new gadolinium \[Gd\]-enhanced lesions on T1-weighted MRI scans or new or enlarging lesions on T2-weighted MRI scans, without double-counting of lesions. ED50 is the dose that gives half of the asymptotic maximum change over placebo. ED90 is the dose that gives 90% of the asymptotic maximum change over placebo.

Pharmacokinetic parameters of BAF312 and selected metabolites
pre-dose, 0.25, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, 24, 36, 48, 72, 96, 144, 216, and 312 hours post dose

The pharmacokineticsof BAF312 will be studied in plasma up to 312 (+/-24) hours post-dose at the following time points: pre-dose, 0.25, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, 24, 36, 48, 72, 96, 144, 216, and 312 (+/-24) hours post dose. Selected metabolites will also be quantified using the same samples as described above. Free plasma circulating fraction of BAF312 will also be investigated to assess whether protein binding is affected by renal impairment. For this purpose a separate blood sample will be taken at the following time point: 4 hours post-dose.

Pharmacokinetic Parameters of BAF312 and Selected Metabolites: Area Under the Plasma Concentration-time Curve From Time Zero to Infinity (AUCinf)
pre-dose, 0.25, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, 24, 36, 48, 72, 96, 144, 216, 312, 408 and 504 hours post dose.

The pharmacokinetics of BAF312 were studied in plasma up to 504 hours post-dose at the following time points: pre-dose, 0.25, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, 24, 36, 48, 72, 96, 144, 216, 312, 408 and 504 hours post dose.

Pharmacokinetic Parameters of BAF312 and Selected Metabolites: Area Under the Plasma Concentration-time Curve From Time Zero to the Time of the Last Quantifiable Concentration (AUClast)
pre-dose, 0.25, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, 24, 36, 48, 72, 96, 144, 216, 312, 408 and 504 hours post dose.

The pharmacokinetics of BAF312 were studied in plasma up to 504 hours post-dose at the following time points: pre-dose, 0.25, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, 24, 36, 48, 72, 96, 144, 216, 312, 408 and 504 hours post dose.

Pharmacokinetic Parameters of BAF312 and Selected Metabolites: Observed Maximum Plasma Concentration Following Drug Administration at Steady State (Cmax)
pre-dose, 0.25, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, 24, 36, 48, 72, 96, 144, 216, 312, 408 and 504 hours post dose

The pharmacokinetics of BAF312 were studied in plasma up to 504 hours post-dose at the following time points: pre-dose, 0.25, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8, 12, 16, 24, 36, 48, 72, 96, 144, 216, 312, 408 and 504 hours post dose

Secondary Endpoints

Number of Participants With at Least One Adverse Event (AE)
From first dose of study drug up to 30 days after last dose of study drug (up to 7 months)
Change From Baseline in Treatment Satisfaction Questionnaire for Medication (TSQM-9)
Baseline up to Day 168
Change in Heart Rate From Baseline to 6 Hours After First Treatment
From the first dose up to 6 hours
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Study Design & Arms

AllocationNA
MaskingNONE
ModelSINGLE_GROUP
PurposeTREATMENT

Treatment Arms

ArmTypeDescription
SiponimodEXPERIMENTALParticipants will receive titrated doses of siponimod tablets, orally, once daily of 0.25 mg on Day 2, 0.5 mg on Day 3, 0.75 mg on Day 4, 1.25 mg on Day 5, and maintenance dose of siponimod 2.0 mg tablets, orally, once daily from Day 6 up to 6 months. As of protocol amendment 3, participants entering the trial converting from fingolimod will start directly with 2 mg dose of siponimod.
Siponimod (BAF312)EXPERIMENTALParticipants started on Day 1 and were uptitrated from 0.25 mg to 2 mg of BAF312 orally over a period of 6 days. After Day 7, participants continued on the treatment epoch for 3 months. During the Core Part of the study, participants participated in a maximum of 3 epochs. Following the Core Part, eligible patients enter the Extension Part during which all receive open-label BAF312.
PlaceboPLACEBO_COMPARATORMatching placebo to BAF312 was administered orally during the Core Part of the trial. Following the Core Part, eligible participants enter the Extension Part during which all receive open-label BAF312.
BAF312EXPERIMENTALDays 1 - 7, IV up titration; days 8 - 14, 10 mg (5 x 2 mg tablets) taken daily orally
BAF312 10 mg/2 mgEXPERIMENTAL10 mg dose in Double Blind Phase and 2 mg in Open Label Phase
BAF312 2 mg/2 mgEXPERIMENTAL2 mg dose in Double Blind Phase and 2 mg in Open Label Phase
BAF312 1.25 mg/2 mgEXPERIMENTAL1.25 mg dose in Double Blind Phase and 2 mg in Open Label Phase
BAF312 .5 mg/2 mgEXPERIMENTAL.5 mg dose in Double Blind Phase and 2 mg in Open Label Phase
BAF312 .25 mg/2 mgEXPERIMENTAL.25 mg dose in Double Blind Phase and 2 mg in Open Label Phase
BAF312 10mg (period 1)EXPERIMENTAL -
BAF312 2 mg (period 1)EXPERIMENTAL -
BAF312 0.5 mg (period 1)EXPERIMENTAL -
BAF312 dose between 0.1 to 8 mg period 2EXPERIMENTAL -
BAF312 dose between 0.1 - 8 mg period 2EXPERIMENTAL -
Placebo (period 1, 2)PLACEBO_COMPARATOR -
severe renal impairmntEXPERIMENTAL -
moderate renal impairmentEXPERIMENTAL -
mild renal impairmentEXPERIMENTAL -
healthy subjectsEXPERIMENTAL -
Mild hepatically impairedEXPERIMENTALTreatment with a single oral dose of 0.25 mg BAF312
Moderate hepatically impairedEXPERIMENTALTreatment with a single oral dose of 0.25 mg BAF312
Severe hepatically impairedEXPERIMENTALTreatment with a single oral dose of 0.25 mg BAF312
Matched healthy subjectsEXPERIMENTALTreatment with a single oral dose of 0.25 mg BAF312

Interventions

NameTypeDescription
SiponimodDRUGSiponimod 2mg tablets taken once daily
BAF312DRUG0.25, 0.5, 1, and 2 mg film-coated tablets
PlaceboDRUGFilm-coated tablets
BAF312 solutionDRUGSolution for intravenous (IV) infusion - 4.5mg/4.5mL
Matching Placebo for BAF312 solutionDRUGSolution for intravenous (IV) infusion - 0mg/4.5mL matching placebo
BAF312 tabletDRUG2 mg film-coated tablet
Matching Placebo for BAF312 tabletDRUG0 mg film-coated tablet matching placebo
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Eligibility Criteria

Age Range18 Years to 65 Years
SexALL
Healthy VolunteersNo
Study Sites55

Key Inclusion Criteria: 1. Signed informed consent. 2. Male or female aged 18 to 65 years (inclusive). 3. Patients with advancing RMS as defined by the principal investigator. 4. Prior history of relapsing MS (RMS), with or without progressive features, according to the 2010 Revised McDonald or Lub...

Countries:United StatesPuerto RicoArgentinaAustraliaAustriaBelgiumBulgariaCanadaChinaCzechiaEstoniaFranceGermanyGreeceHungaryIrelandIsraelItalyJapanLatviaLithuaniaNetherlandsPolandPortugalRomaniaRussiaSlovakiaSpainSwedenSwitzerlandTurkey (Türkiye)United KingdomFinlandNorway
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Frequently asked questions about Siponimod

What is Siponimod used for in Multiple Sclerosis?

Siponimod is an investigational small molecule being developed for the treatment of Multiple Sclerosis, specifically studied in relapsing and advancing forms of the disease. It is designed to be administered orally with dose titration. The drug is currently in Phase 3 clinical development and is not yet approved.

What does Siponimod target?

Siponimod targets the S1PR1 receptor, acting as an agonist. By modulating this receptor, it is believed to influence immune cell trafficking, which is relevant to its potential role in treating Multiple Sclerosis. The drug is a small molecule developed by Novartis AG.

Who makes Siponimod?

Siponimod is developed by Novartis AG, a global healthcare company traded under the ticker NVS. The drug is being investigated as a treatment for Multiple Sclerosis and is currently in Phase 3 clinical trials.

What phase is Siponimod in?

Siponimod is in Phase 3 clinical development for Multiple Sclerosis. It is an investigational drug, meaning it has not received regulatory approval. The completed Phase 3 trial focused on safety and tolerability when converting patients from other disease-modifying therapies to siponimod.

What clinical trials is Siponimod in?

Siponimod has one completed Phase 3 clinical trial registered as NCT03623243. This study, titled 'Safety and Tolerability of Conversion From Oral, Injectable, or Infusion Disease Modifying Therapies to Dose-titrated Oral Siponimod (Mayzent) in Advancing RMS Patients,' enrolled 185 participants with relapsing or advancing Multiple Sclerosis in the United States and Puerto Rico.

Is Siponimod the same as Mayzent?

Yes, Siponimod is also known as Mayzent. The clinical trial NCT03623243 explicitly references Mayzent in its title, confirming that Mayzent is the brand name for siponimod. Both names refer to the same investigational drug being developed by Novartis for Multiple Sclerosis.