Abstract
Background: Siponimod is approved in Australia for adults with secondary progressive multiple sclerosis (SPMS). Prescreen requirements for siponimod include a CYP2C9 genotype test to determine maintenance dosing. An integrated digital platform, ‘MSGo’, was developed by Novartis and RxMx to support Healthcare Professionals and their multiple sclerosis patients. Objective: Data derived exclusively from MSGo was utilised to explore the onboarding experience of siponimod patients in Australia. Methods: The study enrolled >350 adults with SPMS registered in MSGo for siponimod in Australia. Primary endpoint is the average time for onboarding with key secondary endpoints addressing adherence and variables that influence onboarding and adherence. Results: Final data extraction on April 20, 2022 included 368 patients (median age 59y). CYP2C9 genotype testing took a median of 19 days (95%CI 17-21) from registration and maintenance doses of 2mg (n=166) or 1mg (n=27) were initiated as per label recommendations. Mixture-cure modelling estimated 58% of patients will ever initiate siponimod, with median time to initiation of 56d (95%CI 47-59) from registration. Self-reporting of daily treatment had a drop-off of ~25% after the first week of initiation; a continued decline in reporting over time limited assessment of adherence. The study uncovered the important role of care partners, with Cox regression analyses showing that SPMS patients who nominated a care partner were more likely to initiate (HR:2.1, 95%CI 1.5-3.0) and to continue self-reporting their daily medication (HR:2.2, 95%CI 1.3-3.7). A total of 90 patients discontinued the study; 48 prior to and 42 after siponimod exposure. Conclusion: This study provides insights into siponimod onboarding for adults living with SPMS in Australia and demonstrates the impact of MSGo and care partner support during a period challenged by the COVID-19 pandemic.