Q&A 72: Smouldering MS: siponimod or cladribine?

If tolebrutinib were licensed, this patient would be an ideal candidate to be switched to this treatment.

Case study

I am an MS specialist. A colleague told me that you are involved in the Chariot-MS study. I have a young patient who is progressing despite treatment with natalizumab and rituximab, so I was planning to try either cladribine or siponimod for her. Is your preliminary opinion that cladribine may be superior to siponimod for this indication?

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Prof G’s answer

Q1. I have a young patient who is progressing despite treatment with natalizumab and rituximab, so I was planning to try either cladribine or siponimod for her. Is your preliminary opinion that cladribine may be superior to siponimod for this indication?

This question came to me via email earlier this week. It is excellent to know that not only people with MS subscribe to and read MS Selfie but also healthcare professionals (HCPs). Are you surprised? I am.

This patient has smouldering MS. I was told they are relapse-free and have had no new focal lesions on MRI. Using the current Lublin classification system, they would be labelled as having ‘Inactive Secondary Progressive MS’.

To be brutally honest, ……