1.1 Siponimod is recommended, within its marketing authorisation, as an option for treating secondary progressive multiple sclerosis with evidence of active disease (that is, relapses or imaging features of inflammatory activity) in adults. It is recommended only if the company provides siponimod according to the commercial arrangement.
Interferon beta‑1b is the only disease-modifying treatment available for people with active secondary progressive multiple sclerosis. However, few people have it. Most people do not have any disease-modifying treatments. Effective treatment options are therefore very limited.
Clinical trial results show that siponimod reduces the number of relapses and slows disability progression compared with placebo. It is uncertain how effective siponimod is compared with interferon beta‑1b because there is no evidence directly comparing them.
The most plausible cost-effectiveness estimates for siponimod compared with no disease-modifying treatment and with interferon beta‑1b (Extavia) are in the range that NICE normally considers an acceptable use of NHS resources. Therefore, siponimod is recommended.