Multiple sclerosis (MS) is a chronic neurodegenerative disease that affects the central nervous system (CNS). Currently, MS treatment is limited to several Food and Drug Administration (FDA)- and European Medicines Agency (EMA)-approved medications that slow disease progression by immunomodulatory action. Fingolimod and siponimod have similar mechanisms of action, and consequently, their therapeutic effects may be comparable. However, while fingolimod is mainly used for relapsing-remitting MS (RRMS), siponimod, according to EMA label, is recommended for active secondary progressive MS (SPMS). Clinicians and scientists are analysing whether patients can switch from fingolimod to siponimod and identifying the advantages or disadvantages of such a switch from a therapeutic point of view. In this review, we aim to discuss the therapeutic effects of these two drugs and the advantages/disadvantages of switching treatment from fingolimod to siponimod in patients with the most common forms of MS, RRMS and SPMS.

1st Faculty of Medicine Charles University Prague Prague Czech Republic

Brain and Mind Center University of Sydney Sydney Australia

Department of Neurology Faculty of Medicine and University Hospital Hradec Králové Charles University Prague Sokolská 581 500 05 Hradec Králové Czech Republic

Department of Neurology Faculty of Medicine at Palacký University and University Hospital in Olomouc 1 P Pavlova 6 Olomouc Czech Republic

Department of Neurology Medical School Heinrich Heine University Düsseldorf Düsseldorf Germany

Memory Clinic Department of Neurology 2nd Faculty of Medicine Charles University and Motol University Hospital Prague Czech Republic

Multiple Sclerosis Center Sheba Medical Center Tel Hashomer Israel

Neurology Department Sheba Medical Center Tel Hashomer Israel

Sackler School of Medicine Tel Aviv University Tel Aviv Israel

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