The MS Trust is very disappointed that NICE does not recommend ponesimod (Ponvory) as an NHS treatment in England and Wales.
In its draft recommendation, NICE acknowledges that ponesimod reduces the number of relapses and brain lesions compared to Aubagio (teriflunomide) but is unsure of ponesimod’s ability to slow down disability progression. As a result, ponesimod is not considered to be cost-effective for the NHS.
This is NICE’s initial decision and they have asked the manufacturer for more detailed evidence and analysis of the data. The MS Trust has been taking part in the appraisal of ponesimod and we will be replying to NICE’s initial decision.
If you wish to comment on the draft recommendation, you can do so through the NICE website by 5pm, 26 October 2021.
The NICE appraisal committee will meet again to review all the comments received and expects to publish its final decision later this year.
Ponesimod is taken as a tablet, once daily. A low dose is taken initially which is gradually increased over the first week. This reduces the risk of slowing the heart rate.
In a two year clinical trial, ponesimod reduced the risk of relapses by 30% compared to Aubagio (teriflunomide) and reduced the number of new active lesions seen on MRI. Those on ponesimod also had a statistically significant improvement in fatigue symptoms compared to Aubagio. There was a trend toward less disability progression on ponesimod, but this was not statistically different to Aubagio.
The most common side effects reported in clinical trials were nasopharyngitis (common cold), headache, chest infections and an increase in liver enzymes measured in the blood. Seizures and macular oedema (swelling at the back of the eye) occurred more frequently in those taking ponesimod.
Ponesimod belongs to the same class of drugs as Gilenya (fingolimod). It works by retaining lymphocytes (immune cells) in lymph nodes. The number of lymphocytes reaching the brain is decreased, which reduces the immune attack on nerve cells in the brain and spinal cord.
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