University Hospital Center Zagreb

Author Of 1 Presentation

Disease Modifying Therapies – Risk Management Poster Presentation

P0297 - Autonomic nervous system abnormalities may predict cardiovascular changes after initiation of siponimod in the treatment of SPMS (ID 1451)

Speakers
Presentation Number
P0297
Presentation Topic
Disease Modifying Therapies – Risk Management

Abstract

Background

The aim of this study was to identify whether autonomic nervous system (ANS) dysfunction identified prior treatment initiation can predict siponimod related decrease in HR after treatment initiation.

Objectives

Primary outcome was to identify whether HRV parameters identified prior treatment initiation can predict decrease in HR after taking the first dose of the drug.

Secondary outcomes were to identify whether HRV parameters identified prior treatment initiation can predict changes in sBP and dBP after taking the first dose of the drug.

Methods

In 26 people with secondary progressive multiple sclerosis (SPMS) (16 females, mean age 50.96±9.48, median EDSS 6.0, range 3.0-6.5) the following ANS testing protocol was applied: 10-min supine resting position, Valsalva maneuver, deep breathing test, 10 min tilt-up table test, 5-min supine resting period, ingestion of siponimod, followed by 180-min supine resting period recordings. Heart rate variability (HRV) parameters were investigated as possible predictors of decrease in heart rate HR (ΔHR) after treatment initiation. According to pharmacokinetic properties of siponimod, average values after 1 hour of siponimod ingestion were compared to the values prior to siponimod ingestion.

Results

After treatment initiation, there was a statistically significant drop in HR (71.1±9.2 to 66.3±8.1, p<0.001) and elevation of systolic blood pressure (sBP) (113.2±12.4 to 117.1±10.8, p=0.04). Values of the diastolic BP (dBP) followed similar trend as did sBP, however not reaching statistically significance (72.8±9.6 to 74.9±8.3, p=0.13). In a multivariable regression model, disease duration and standard deviation of NN intervals (SDNN) were identified as independent predictors for ΔHR, where increase in SDNN and longer disease duration predict smaller ΔHR. Normalized high frequency (HFnu) component was identified as negative predictor of increase in sBP and dBP.

Conclusions

ANS abnormalities may predict cardiovascular abnormalities associated with treatment initiation with siponimod.

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