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Megan Regina Weigel
Dear Healthcare Professional,
I am pleased to share some information about MAYZENT® (siponimod)—an oral, selective S1P receptor modulator for progressing RMS patients.1 Below you'll find information about how MAYZENT targets 2 key receptors that are thought to play a role in RMS inflammation and neurodegeneration.1-5
I hope you find this information helpful as you continue to formulate treatment strategies that address the individual needs of patients in your practice.
Thank you,
Megan Regina Weigel, DNP, APRN-c, MSCN
Full Prescribing Information  |  Important Safety Information  |  Medical Information
Get your patients started at CoverMyMeds® or download the Start Form
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 MAYZENT works in the periphery to limit active lymphocytes from leaving the lymph nodes, which may reduce lymphocyte migration into the CNS1
 Lymphocytes are stored, not destroyed, in the lymph nodes; upon discontinuation, blood lymphocyte counts rapidly recover within 10 days1†‡
The mechanism by which siponimod exerts therapeutic effects on MS is unknown but may involve reduction of lymphocytes in the CNS.1
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  CNS=central nervous system; DMT=disease-modifying therapy; EDSS=Expanded Disability Status Scale; MOA=mechanism of action; MS=multiple sclerosis; RMS=relapsing MS; S1P=sphingosine 1‑phosphate.
* Based on animal studies.1
In 90% of patients.1
After stopping MAYZENT treatment, residual lowering of peripheral lymphocyte count may persist for up to 3-4 weeks after the last dose.1
MAYZENT is the first and only oral DMT studied
and proven in more progressed RMS patients1,8§||
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§ Patients in EXPAND had a mean EDSS score of 5.4.9
|| See Trial Design below.
MAYZENT® (siponimod) 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.
•  Patients with a CYP2C9*3/*3 genotype
•  In the last 6 months, experienced myocardial infarction, unstable angina, stroke, TIA, decompensated heart failure requiring hospitalization, or Class III/IV heart failure
•  Presence of Mobitz type II second‑degree, third-degree atrioventricular block, or sick sinus syndrome, unless patient has a functioning pacemaker
Infections: MAYZENT may increase risk of infections with some that are serious in nature. Life-threatening and rare fatal infections have occurred.
Before starting MAYZENT, review a recent complete blood count (CBC) (ie, within 6 months or after discontinuation of prior therapy). Delay initiation of treatment in patients with severe active infections until resolved. Employ effective treatments and monitor patients with symptoms of infection while on therapy. Consider discontinuing treatment if patient develops a serious infection.
Cases of fatal cryptococcal meningitis (CM) were reported in patients treated with another sphingosine 1-phosphate (S1P) receptor modulator. Rare cases of CM have occurred with MAYZENT. If CM is suspected, MAYZENT should be suspended until cryptococcal infection has been excluded. If CM is diagnosed, appropriate
treatment should be initiated.
No cases of progressive multifocal leukoencephalopathy (PML) were reported in MAYZENT clinical trials; however, they have been observed in patients treated with another sphingosine 1-phosphate (S1P) receptor modulator and other multiple sclerosis (MS) therapies. If PML is suspected, MAYZENT should be discontinued.
Cases of herpes viral infection, including one case of reactivation of varicella zoster virus leading to varicella zoster meningitis, have been reported. Patients without a confirmed history of varicella zoster virus (VZV) or without vaccination should be tested for antibodies before starting MAYZENT. If VZV antibodies are not present or detected, then VZV immunization is recommended and MAYZENT should be initiated 4 weeks after vaccination.
Use of live vaccines should be avoided while taking MAYZENT and for 4 weeks after stopping treatment.
Caution should be used when combining treatment (ie, anti‑neoplastic, immune-modulating, or immunosuppressive therapies) due to additive immune system effects.
Macular Edema: In most cases, macular edema occurred within 4 months of therapy. Patients with history of uveitis or diabetes are at an increased risk. Before starting treatment, an ophthalmic evaluation of the fundus, including the macula, is recommended and at any time if there is a change in vision. The use of MAYZENT in patients with macular edema has not been evaluated; the potential risks and benefits to the individual patient should be considered.
Bradyarrhythmia and Atrioventricular Conduction Delays: Prior to initiation of MAYZENT, an ECG should be obtained to determine if preexisting cardiac conduction abnormalities are present. In all patients, a dose titration is recommended for initiation of MAYZENT treatment to help reduce cardiac effects.
MAYZENT was not studied in patients who had:
•  In the last 6 months, experienced myocardial infarction, unstable angina, stroke, TIA, or decompensated heart failure requiring hospitalization
•  New York Heart Association Class II‑IV heart failure
•  Cardiac conduction or rhythm disorders, including complete left bundle branch block, sinus arrest or sino-atrial block, symptomatic bradycardia, sick sinus syndrome, Mobitz type II second-degree AV‑block or higher-grade AV‑block (either history or observed at screening), unless patient has a functioning pacemaker
•  Significant QT prolongation (QTc greater than 500 msec)
•  Arrhythmias requiring treatment with Class Ia or Class III anti‑arrhythmic drugs
Reinitiation of treatment (initial dose titration, monitoring effects on heart rate and AV conduction [ie, ECG]) should apply if ≥4 consecutive daily doses are missed.
Respiratory Effects: MAYZENT may cause a decline in pulmonary function. Spirometric evaluation of respiratory function should be performed during therapy if clinically warranted.
Liver Injury: Elevation of transaminases may occur in patients taking MAYZENT. Before starting treatment, obtain liver transaminase and bilirubin levels. Closely monitor patients with severe hepatic impairment. Patients who develop symptoms suggestive of hepatic dysfunction should have liver enzymes checked, and MAYZENT should be discontinued if significant liver injury is confirmed.
Increased Blood Pressure: Increase in systolic and diastolic pressure was observed about 1 month after initiation of treatment and persisted with continued treatment. During therapy, blood pressure should be monitored and managed appropriately.
Fetal Risk: Based on animal studies, MAYZENT may cause fetal harm. Women of childbearing potential should use effective contraception to avoid pregnancy during and for 10 days after stopping MAYZENT therapy.
Posterior Reversible Encephalopathy Syndrome (PRES): Rare cases of PRES have been reported in patients receiving a
sphingosine 1-phosphate (S1P) receptor modulator. Such events have not been reported for patients treated with MAYZENT in clinical trials.
If patients develop any unexpected neurological or psychiatric symptoms, a prompt evaluation should be considered. If PRES is suspected, MAYZENT should be discontinued.
Unintended Additive Immunosuppressive Effects From Prior Treatment or After Stopping MAYZENT: When switching from drugs with prolonged immune effects, the half‑life and mode of action of these drugs must be considered to avoid unintended additive immunosuppressive effects.
Initiating treatment with MAYZENT after treatment with alemtuzumab is not recommended.
After stopping MAYZENT therapy, siponimod remains in the blood for up to 10 days. Starting other therapies during this interval will result in concomitant exposure to siponimod.
Lymphocyte counts returned to the normal range in 90% of patients within 10 days of stopping therapy. However, residual pharmacodynamic effects, such as lowering effects on peripheral lymphocyte count, may persist for up to 3-4 weeks after the last dose. Use of immunosuppressants within this period may lead to an additive effect on the immune system, and therefore, caution should be
applied 3-4 weeks after the last dose of MAYZENT.
Severe Increase in Disability After Stopping MAYZENT: Severe exacerbation of disease, including disease rebound, has been rarely reported after discontinuation of an S1P receptor modulator. The possibility of severe exacerbation of disease should be considered after stopping MAYZENT treatment, thus patients should be monitored upon discontinuation.
Most Common Adverse Reactions: Most common adverse reactions (>10%) are headache, hypertension, and transaminase increases.
Please click here for full Prescribing Information, including Medication Guide.
Trial design: EXPAND was a randomized, double-blind, placebo‑controlled study in 1651 more progressed patients in RMS. The inclusion criteria were: documented evidence of progression in the 2 years prior to enrollment, no evidence of relapse in the 3 months prior to study enrollment, and an EDSS score of 3.0-6.5 points at study entry. Patients were randomized 2:1 to receive either once-daily MAYZENT 2 mg or placebo. Evaluations were performed
at screening, every 3 months, and when relapses occurred. MRI evaluations were performed at screening and every 12 months. The follow-up duration was 37 months.1,9
MRI=magnetic resonance imaging.
References: 1. Mayzent [prescribing information]. East Hanover, NJ: Novartis Pharmaceuticals Corp; July 2020. 2. O'Sullivan C, Schubart A, Mir AK, Dev KK. The dual S1PR1/S1PR5 drug BAF312 (siponimod) attenuates demyelination in organotypic slice cultures. J Neuroinflammation. 2016;13:31. 3. Gergely P, Nuesslein-Hildesheim B, Guerini D, et al. The selective sphingosine 1-phosphate receptor modulator BAF312 redirects lymphocyte distribution and has species-specific effects on heart rate. Br J Pharmacol. 2012;167(5):1035-1047. 4. Mannioui A, Vauzanges Q, Fini JB, et al. The Xenopus tadpole: An in vivo model to screen drugs favoring remyelination. Mult Scler. 2018;24(11):1421-1432. 5. Choi JW, Chun J. Lysophospholipids and their receptors in the central nervous system. Biochim Biophys Acta. 2013;1831(1):20-32. 6. Briard E, Rudolph B, Desravaud S, Krauser JA, Auberson YP. MS565: A SPECT Tracer for Evaluating the Brain Penetration of BAF312 (Siponimod). ChemMedChem. 2015;10(6):1008-1018. 7. Behrangi N, Fischbach F, Kipp M. Mechanism of siponimod: anti-inflammatory and neuroprotective mode of action. Cells. 2019;8(24):1-11 doi:10.3390/cells8010024. 8. Data on file. First and only progressing RMS treatment. Novartis Pharmaceuticals Corp; July 2019. 9. Kappos L, Bar-Or A, Cree BAC, et al; for the EXPAND Clinical Investigators. Siponimod versus placebo in secondary progressive multiple sclerosis (EXPAND): a double-blind, randomized, phase 3 study. Lancet. 2018;391(10127):1263-1272.
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