Mayzent (siponimod) is a disease-modifying treatment for adults with active secondary progressive multiple sclerosis (SPMS) or relapsing-remitting MS (RRMS). It is taken as a once-daily tablet.

Siponimod belongs to the same class as Gilenya (fingolimod): it is a sphingosine 1-phosphate (S1P) receptor modulator. It works by trapping certain immune cells (lymphocytes) in lymph nodes, preventing them from reaching the brain and spinal cord and causing inflammation.

Mayzent is specifically studied in active SPMS patients, showing a reduction in disability progression.

Treatment does not start at the full dose straight away. A starter pack is used to gradually increase the dose over the first week, which helps reduce the risk of heart rate slowing. Your neurologist will provide the starter pack and walk you through the schedule.

Mayzent can be taken with or without food. Take at the same time each day.

Before starting, you will need a genetic test (CYP2C9 genotyping) as some people have a genetic variant that affects how they metabolise siponimod and require a lower maintenance dose.

First-dose monitoring (heart rate and blood pressure) is required if you restart Mayzent after a gap of 4 or more days.

If you miss a dose during the titration period, start the titration again from the beginning with the starter pack. During maintenance, take the missed dose the same day if you remember. If a day has passed, skip and continue from the next day. If you miss four or more consecutive doses, a new titration is required.

Seek immediate medical attention. Overdose can cause serious heart rate slowing and low blood pressure.

• Store below 30°C
• Keep in the original blister pack to protect from moisture
• Keep out of reach of children

Common side effects:

• Headache
• High blood pressure
• Elevated liver enzymes: liver blood tests are required
• Low lymphocyte counts: blood count monitoring is required
  

Serious side effects:

• Heart rate slowing (bradycardia): mainly a risk at the first dose and when restarting after a break. ECG and heart monitoring during initiation
• Macular oedema: blurred or distorted vision. An eye examination is recommended 3 to 4 months after starting
• Serious infections: low lymphocyte counts increase risk
• PML: rare but serious brain infection. Report new neurological symptoms
• Fetal harm: siponimod is harmful to an unborn baby. Effective contraception must be used during and for 10 days after stopping treatment

A full cardiovascular, liver, eye, and blood count assessment is part of starting Mayzent.

• Beta-blockers and other heart-rate-slowing medicines: increase risk of bradycardia at initiation
• CYP2C9 and CYP3A4 inhibitors or inducers: can alter siponimod levels
• Live vaccines: not permitted during or for 4 weeks after stopping
  

Tell your neurologist and all treating doctors about all medicines you are taking.

What is the genetic test for and do I need it?

A CYP2C9 gene test is required before starting Mayzent. Some people carry a genetic variation (CYP2C9*3/*3) that means they metabolise siponimod very slowly. For these individuals, the standard 2 mg dose is too high and they require a lower maintenance dose of 1 mg. Without the genetic test, you cannot safely start Mayzent. Your doctor will arrange this test before prescribing.

How is Mayzent different from Gilenya?

Both medicines belong to the same class and work similarly. The key differences are that Mayzent is specifically approved for secondary progressive MS (in addition to RRMS), and it requires a CYP2C9 genetic test before starting. Mayzent also has a slightly different interaction and side effect profile. Your neurologist will consider which is most appropriate for your type of MS and individual circumstances.

Ace provides accurate and independent information medically reviewed on prescription medications. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment.