Q&A 83: cladribine vs. siponimod vs. tolebrutinib for smouldering MS

My neurologist has suggested either cladribine or siponimod. What would you recommend?

Case

I am a 44-year-old woman with longstanding MS. I was initially treated with interferon-beta (Avonex) for several years, but I stopped to have a family. I never restarted treatment and have not been on any DMT for over 15 years. I have had no relapses, but I am steadily getting worse. Reduced walking distance, fatiguable foot drop, poor balance and worsening bladder symptoms. My neurologist has suggested either cladribine or siponimod. What would you recommend?

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Answers

This patient has secondary progressive MS (SPMS), and the fact that her neurologist, who works in the NHS, has recommended siponimod and cladribine suggests she must have active MS SPMS …..