Ponesimod is a potent orally active, selective sphingosine-1-phosphate receptor 1 (S1P1) immunomodulator.
Ponesimod prevents lymphocytes from leaving lymph nodes, thereby reducing circulating blood lymphocyte counts and preventing infiltration of lymphocytes into target tissues. The lymphocyte count reduction is rapid, dose-dependent, sustained upon continued dosing, and quickly reversible upon discontinuation. Initial data suggest that ponesimod does not cause lymphotoxicity by destroying/depleting lymphocytes or interfering with their cellular function. Other blood cells e.g. cells of the innate immune system are largely unaffected. Ponesimod is therefore considered a promising new oral agent for the treatment of a variety of autoimmune disorders.
OPTIMUM (Oral Ponesimod versus Teriflunomide In relapsing MUltiple sclerosis) is a Phase III multi-center, randomized, double-blind, parallel-group, active-controlled superiority study to compare the efficacy and safety of ponesimod to teriflunomide (Aubagio®) in patients with relapsing multiple sclerosis (RMS). OPTIMUM aims to determine whether ponesimod is more efficacious than teriflunomide in reducing relapses. The study, which is expected to last about 4 years, completed recruitment in March 2017, with 1133 patients randomized into the trial in 2 groups to receive ponesimod 20 mg/day or teriflunomide 14 mg/day.
POINT (POnesImod aNd Tecfidera) is a prospective, multicenter, randomized, double-blind, parallel group, add-on, placebo-controlled, superiority study with ponesimod in patients with RMS. The study is designed to compare the efficacy, safety, and tolerability of add-on therapy with ponesimod 20 mg vs. placebo in adult patients with active RMS who are treated with dimethyl fumarate (Tecfidera®). Approximately 600 patients receiving dimethyl fumarate twice daily for at least 6 months will be randomized in a 1:1 ratio to ponesimod 20 mg or placebo. Treatment will be given until the last patient enrolled into the study has been treated for 60 weeks, with expected average treatment duration of 2 years, and for a maximum duration of 3.3 years. Enrollment has commenced, with the first patient randomized in March 2017, and the study is being conducted under a Special Protocol Assessment (SPA) agreement with the FDA.
The decision to move into Phase III development was based on the Phase IIb dose-finding study with ponesimod in patients with relapsing-remitting multiple sclerosis. A total of 464 patients were randomized into this study and the efficacy, safety and tolerability of three ponesimod doses (10, 20, and 40 mg/day) versus placebo, administered once daily for 24 weeks.
The primary endpoint of this study was defined as the cumulative number of new gadolinium-enhancing lesions on T1-weighted magnetic resonance imaging (MRI) scans at weeks 12, 16, 20, and 24 after study drug initiation. A key secondary endpoint of this study was the annualized relapse rate over 24 weeks of treatment. Patients who completed 24 weeks of treatment were offered the opportunity to enter into an extension study. This ongoing trial is investigating the long-term safety, tolerability, and efficacy of 10 and 20 mg/day of ponesimod in patients with relapsing-remitting multiple sclerosis, in a double-blind fashion. Following a recommendation by the IDMC, patients on 10 mg are being switched to 20 mg as of March 2017.
The study continues to provide extensive safety and efficacy information for ponesimod in this indication, with some patients treated for more than 6 years. The safety database from all studies with ponesimod now comprises more than 1,300 patients and healthy volunteers.
2015 – Phase III program in multiple sclerosis initiated
2011 – Phase IIb dose-finding study in multiple sclerosis successfully completed
2006 – Entry-into-man
2004 – Preclinical development initiated
Olsson T et al. J Neurol Neurosurg Psychiatr. 2014 Nov;85(11):1198-208. doi: 10.1136/jnnp-2013-307282. Epub 2014 Mar 21
Freedman M.S, et al. Multiple Sclerosis Journal, 2012; 18 (4 suppl): 420 (P923).
Fernández Ó, et al. Multiple Sclerosis Journal, 2012; 18 (4 suppl): 417 (P919).
Piali L, Froidevaux S, Hess P, et al. J Pharmacol Exp Ther 337(2):547-56, 2011
Bolli MH, Abele S, Binkert C, et al. J Med Chem. 53(10):4198-211, 2010
Kappos L et al. N Engl J Med. 362(5):387-401, 2010
All trademarks are legally protected by their respective owners.