In a trial in 1133 patients, most of whom had relapsing-remitting multiple sclerosis, ponesimod's harm-benefit balance was no better than that of teriflunomide, a drug to avoid in this clinical situation. Ponesimod's adverse effect profile seems as burdensome as that of the other sphingosine 1-phosphate receptor modulators, such as fingolimod, and includes serious cardiac and hepatic harms. In patients with a relapsing-remitting form of multiple sclerosis, the most common form of this disease, neurological disorders develop or worsen during relapses, and regress completely or partially between relapses. It commonly progresses to a "secondary progressive" form, characterised by steady worsening of the neurological disorders and disability, with or without relapses. "Relapsing" multiple sclerosis encompasses the relapsing-remitting form and the secondary progressive form with relapses (1,2).
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