What is Secondary Progressive MS?

Secondary Progressive Multiple Sclerosis (SPMS) is a phase of multiple sclerosis that follows the relapsing-remitting stage. In SPMS, patients experience a steady worsening of neurological function with or without relapses. This progression occurs as the protective myelin sheath around nerve fibers deteriorates, disrupting nerve signals and causing increasing disability.

Approximately 65% of people initially diagnosed with Relapsing-Remitting MS (RRMS) transition to SPMS within 15-20 years. The hallmark of SPMS is continuous neurological decline independent of relapses, though some patients may still experience occasional flare-ups, especially in early SPMS. Symptoms typically include increasing difficulty with mobility, balance, coordination, and cognitive function.

How Mavenclad Works for MS Patients

Mavenclad (cladribine) functions as a selective immune reconstitution therapy, targeting specific immune cells involved in the MS disease process. The medication works by reducing lymphocytes—particularly B and T cells—which are white blood cells that play a role in the autoimmune response that damages the central nervous system in MS.

Unlike many MS medications that require ongoing daily or monthly administration, Mavenclad follows a unique dosing schedule. Treatment consists of two treatment courses given one year apart, with each course comprising two treatment weeks separated by one month. This short-course oral therapy provides up to four years of disease control with just 20 days of treatment.

The selective nature of Mavenclad allows it to target problematic immune cells while sparing other components of the immune system. This selective approach potentially offers disease control with fewer long-term immune suppression concerns compared to some other therapies.

Effectiveness for Secondary Progressive MS

Mavenclad's approval for multiple sclerosis focuses primarily on active relapsing forms, including relapsing-remitting MS and active secondary progressive MS. For SPMS patients who still experience relapses or show new MRI activity, Mavenclad may help reduce disease activity and potentially slow progression.

Clinical data from the CLARITY and CLARITY Extension studies demonstrated Mavenclad's ability to reduce relapse rates by up to 58% compared to placebo. Additionally, the medication showed a 33% reduction in disability progression and significant reductions in brain lesions as measured by MRI.

However, it's important to note that Mavenclad is not typically recommended for non-active SPMS—cases where there are no relapses or new MRI lesions but disability continues to worsen. For these patients, EMD Serono, the manufacturer of Mavenclad, and neurologists may recommend other treatment approaches.

Treatment Comparison for SPMS

When considering treatment options for Secondary Progressive MS, several medications may be evaluated alongside Mavenclad:

Medication Administration Approved for Active SPMS Treatment Schedule
Mavenclad (EMD Serono) Oral tablets Yes Two treatment courses over two years
Siponimod (Novartis) Oral tablets Yes Daily
Ocrelizumab (Biogen) Intravenous infusion Yes Every six months
Alemtuzumab (Sanofi Genzyme) Intravenous infusion For active relapsing forms Two treatment courses one year apart

Each medication offers different benefits and considerations. Mavenclad stands out for its short-course therapy approach, requiring just 20 total days of treatment over two years. Siponimod is specifically approved for SPMS and taken daily, while Ocrelizumab requires twice-yearly infusions but has shown efficacy in both relapsing MS and primary progressive MS.

Treatment decisions should be individualized based on disease activity, previous treatment response, side effect profiles, and patient preferences. Neurologists typically consider factors such as relapse frequency, MRI activity, disability progression rate, and comorbidities when recommending treatment options.

Benefits and Drawbacks of Mavenclad

Benefits of Mavenclad for SPMS patients include:

  • Convenient oral administration without daily or frequent dosing
  • Short treatment courses (just 10 days per year for two years)
  • No routine monitoring requirements after the initial treatment period
  • Demonstrated efficacy in reducing relapses and MRI activity
  • Potential for extended disease control beyond the treatment period

Potential drawbacks and considerations include:

  • Limited data specifically for non-active SPMS patients
  • Risk of lymphopenia (low lymphocyte counts)
  • Increased risk of infections, particularly herpes zoster
  • Need for effective contraception during and for 6 months after treatment
  • Contraindicated in patients with certain conditions including active infections, pregnancy, and some malignancies

The National MS Society emphasizes the importance of early and effective treatment for MS patients, including those transitioning to SPMS. The goal of treatment is to reduce disease activity that contributes to progression and preserve function for as long as possible.

Patient monitoring typically includes blood tests before starting treatment and periodically throughout, along with regular neurological assessments and MRI scans to evaluate treatment response. MS International Federation resources can provide additional guidance for patients considering treatment options.

Conclusion

Mavenclad represents an important treatment option for patients with active Secondary Progressive MS who continue to experience relapses or show new lesions on MRI. Its unique short-course oral therapy approach offers convenience while potentially providing extended disease control. However, treatment decisions should always be individualized, weighing benefits against potential risks and considering the specific characteristics of each patient's disease course. Consultation with a neurologist specializing in MS is essential to determine if Mavenclad is appropriate for your specific situation and to discuss all available treatment options. As research continues, our understanding of how to effectively manage SPMS continues to evolve, offering hope for improved outcomes for patients living with this challenging form of multiple sclerosis.

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This content was written by AI and reviewed by a human for quality and compliance.