Jeffrey Cohen, MD: S1P Modulator Development in Multiple Sclerosis

“The hope was that by developing more selective S1P modulators, that we would maintain the efficacy of fingolimod but avoid some of the off-target adverse effects.”

Over the last few decades, the pipeline of therapies developed for multiple sclerosis (MS) treatment that have successfully navigated the path to regulatory approval. One such class of medications is the sphingosine-1-phosphate (S1P) modulators, the first member of which to be approved was fingolimod (Gilenya; Novartis), which doubled as the first oral agent for the disease.

Over the years, the continued study of fingolimod has allowed for the identification of the need for more selective agents, in part due to the cardiac monitoring of patients that is required with fingolimod. Since then, 2 more agents—siponimod (Mayzent; Novartis) and ozanimod (Zeposia; Bristol Myers Squibb)—have entered the market and another—ponesimod (Janssen)—is before the FDA in the form of a new drug application.

In an interview with NeurologyLive, Jeffrey Cohen, MD, director, Mellen Center for MS Treatment and Research, Cleveland Clinic, explained how the class has been developed to this point, and offered a look at how the S1P modulator class differs in mechanism of action from the other available agents in the MS treatment arsenal.