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Long-term extension data are important when treating a chronic progressive disorder because early trial gains may be difficult to sustain. Follow-up from EXPAND and its extension showed that patients who received continuous siponimod maintained lower risks of six-month confirmed disability progression and cognitive processing-speed worsening compared with participants who initially received placebo and later switched to siponimod. MRI measures also supported continued suppression of disease activity and brain atrophy. These findings strengthen the case for early initiation of effective therapy in patients with active secondary progressive MS, although the extension is open-label and therefore less robust than the randomized core study. For HCPs, the key clinical lesson is that delaying treatment in an actively inflammatory SPMS phenotype may leave avoidable disability on the table. At the same time, treatment requires ongoing assessment of efficacy, adverse effects and disease activity. The study fits IANCON's emphasis on long-term management of complex neurological disease and demonstrates how extension studies can complement randomized trial evidence.
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Long-term extension data are important when treating a chronic progressive disorder because early trial gains may be difficult to sustain. Follow-up from EXPAND and its extension showed that patients who received continuous siponimod maintained lower risks of six-month confirmed disability progression and cognitive processing-speed worsening compared with participants who initially received placebo and later switched to siponimod. MRI measures also supported continued suppression of disease activity and brain atrophy. These findings strengthen the case for early initiation of effective therapy in patients with active secondary progressive MS, although the extension is open-label and therefore less robust than the randomized core study. For HCPs, the key clinical lesson is that delaying treatment in an actively inflammatory SPMS phenotype may leave avoidable disability on the table. At the same time, treatment requires ongoing assessment of efficacy, adverse effects and disease activity. The study fits IANCON's emphasis on long-term management of complex neurological disease and demonstrates how extension studies can complement randomized trial evidence.
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