Swiss Study of the Impact of Mayzent on SPMS Patients in a Long-term Non-interventional Study

Disability progression based on the EDSS score is defined as a 1 point increase from baseline in patients with a baseline score of ≤ 5, or a 0.5 point increase in patients with a baseline score of ≥5.5. As part of a secondary endpoint to this study, the deterioration of the EDSS of ≥1 point (baseline EDSS ≤ 5) or 0.5 points (baseline EDSS ≥5.5) must be confirmed after 6 months. This is called 6-month confirmed progression (6M-CDPEDSS). EDSS values to confirm progression must not be determined during an attack. The maximum duration of an attack is limited to 90 days

The SDMT is a sensitive and specific test for examining attention, concentration and information processing speed, which are typically impaired in cognitively impaired MS patients.

The patients receive an SDMT test sheet. At the beginning of this sheet there are 9 numbers paired with 9 associated individual symbols. Below that are further lines with symbols and empty boxes. The patients must now verbally assign the correct numbers to the symbols as quickly as possible. Exercise examples are given at the beginning of the test which are not taken into account when evaluating the test. The number of correctly assigned items within 90 seconds results into the test score. The total duration of the test is about 5 minutes.

SDMT: ≥4.0-point confirmed worsening from baseline score sustained for at least 6 months respectively

The T25-FW is an objective and quantitative test of the lower extremities (Motl et al., 2017). This stops the time in seconds that a patient needs to walk 25 feet (7.62 m). The patient should walk as quickly and safely as possible. This test is carried out twice in succession and the mean value of the time required is documented in seconds. An improvement or deterioration of 20% is seen as a clinical meaningful change (Motl et al., 2017).

The EQ-5D patient questionnaire is a generic multidimensional measuring instrument for describing health-related quality of life (EuroQol, 1999). The five domains mobility, ability to take care of oneself, everyday activities, pain / discomfort and anxiety / depression are considered. For the individual dimensions, the most appropriate answer from three given options is selected (1 = no problem, 2 = moderate problem, 3 = major problem). In addition, the patient marks the current state of health on a scale from 0 (worst-conceivable state of health) to 100 (best-conceivable state of health).

The FSMC is a patient questionnaire to clarify cognitive and motor fatigue, a typical symptom of MS (Penner et al., 2009). With the help of the FSMC, a cognitive, a motor, and a total score are determined. Increased scores indicate higher impairment caused by fatigue.

A 5-point scale (ranging from 'does not apply at all' to 'applies completely') produces a score between 1 and 5 for each scored question.

BDI is a patient questionnaire for measuring the severity of depression (Beck, 1972). Depression is a common symptom in MS and can cause fatigue. With the BDI test we assess the frequency of depression and its correlation to fatigue. This results in a scale from 0 to 63. The level of depression is evaluated according to the table below:

• 0-13: no or minimal symptoms
• 14-19: mild symptoms
• 20-28: moderate symptoms
• 29-63: severe depressive symptoms

ESS is a patient questionnaire to measure daytime sleepiness (Ibanez et al, 2017). Results of the ESS will allow to correlate whether observed fatigue might be attributed to daytime sleepiness. The level of sleepiness is evaluated according to the table below:

0-5 Lower Normal Daytime Sleepiness 6-10 Higher Normal Daytime Sleepiness 11-12 Mild Excessive Daytime Sleepiness 13-15 Moderate Excessive Daytime Sleepiness 16-24 Severe Excessive Daytime Sleepiness