This handout is for secondary progressive multiple sclerosis. Your care team identified this based on: rrms patient with insidious progression ≥6 mo independent of relapses (lublin 2014 pmid 24871874 needs_source_review).
Other reasons your team may use this plan: edss step progression confirmed at 3 + 6 mo without intervening relapse — pira; disproportionate cord/brain atrophy on annual mri — neurodegenerative pattern; worsening spasticity / neurogenic bladder / cognitive decline without relapse.
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| siponimod | 0.25 mg titrate to 2 mg PO daily over 6 days (CYP2C9 *1/*3 or *2/*3 → 1 mg max) | PO | daily | EXPAND (Kappos Lancet 2018 PMID 29576505 NEEDS_SOURCE_REVIEW) — first FDA-approved DMT for active SPMS; 21% relative risk reduction in 3-mo CDP; first-dose 6-h ECG monitoring |
| ocrelizumab (off-label active SPMS) | 300 mg IV × 2 then 600 mg q6 months | IV | q6 months | OPERA extension supports off-label use in active SPMS; OPERA PMID 28002679 |
| cladribine (active SPMS) | Weight-based 3.5 mg/kg cumulative oral | PO | pulsed years 1+2 | CLARITY extension supports active SPMS; PMID 20089960 |
Plan: SPMS DMT — siponimod first-line for active SPMS; symptomatic dominant for non-active (AAN 2024; EXPAND PMID 29576505)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
PT/OT/SLP; spasticity clinic + intrathecal baclofen pump consideration if refractory; pulmonary surveillance (FVC); palliative + advance directives at EDSS ≥7; caregiver support (AAN 2024)
Guideline: AAN 2024 MS DMT guideline + ECTRIMS 2024 + EXPAND siponimod (Kappos Lancet 2018 PMID 29576505)