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EXPAND was a landmark phase 3 trial because few disease-modifying therapies had previously demonstrated an effect on disability progression in secondary progressive multiple sclerosis. The double-blind randomized study compared once-daily siponimod with placebo in people with SPMS. Siponimod significantly reduced the risk of three-month confirmed disability progression and also reduced relapse activity and MRI measures of inflammation and brain volume loss. The benefit was particularly relevant in patients with evidence of ongoing inflammatory activity, helping establish the idea that selected SPMS patients can still benefit from disease-modifying therapy. For HCPs, the practical implication is that the transition from relapsing MS to progressive disease should not automatically end consideration of active treatment. Disease phenotype matters. Patients with recent relapses or MRI activity may have more to gain than patients with purely non-inflammatory progression. Siponimod also requires appropriate safety screening and CYP2C9 genotype assessment. The trial is directly relevant to IANCON's interest in modern MS treatment and the distinction between inflammatory activity and progression.
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EXPAND was a landmark phase 3 trial because few disease-modifying therapies had previously demonstrated an effect on disability progression in secondary progressive multiple sclerosis. The double-blind randomized study compared once-daily siponimod with placebo in people with SPMS. Siponimod significantly reduced the risk of three-month confirmed disability progression and also reduced relapse activity and MRI measures of inflammation and brain volume loss. The benefit was particularly relevant in patients with evidence of ongoing inflammatory activity, helping establish the idea that selected SPMS patients can still benefit from disease-modifying therapy. For HCPs, the practical implication is that the transition from relapsing MS to progressive disease should not automatically end consideration of active treatment. Disease phenotype matters. Patients with recent relapses or MRI activity may have more to gain than patients with purely non-inflammatory progression. Siponimod also requires appropriate safety screening and CYP2C9 genotype assessment. The trial is directly relevant to IANCON's interest in modern MS treatment and the distinction between inflammatory activity and progression.
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