Mavenclad (cladribine) vs Ponvory (ponesimod)

Mavenclad (cladribine) and Ponvory (ponesimod) are both oral medications approved for the treatment of relapsing forms of multiple sclerosis (MS), but they work through different mechanisms of action. Mavenclad is a purine analog that selectively targets lymphocytes and leads to a temporary reduction in certain white blood cells, which is thought to reduce the immune attack on the nervous system. Ponvory, on the other hand, is a sphingosine-1-phosphate receptor modulator that traps lymphocytes in lymph nodes, preventing them from contributing to the autoimmune response in the central nervous system. When deciding between the two, patients should consider factors such as dosing schedule, Mavenclad is taken as a short course annually for two years, while Ponvory is taken daily, as well as the side effect profile and any pre-existing conditions that may affect drug suitability. It is essential to consult with a healthcare provider to evaluate individual health status, lifestyle, and treatment goals to determine the most appropriate medication.

Difference between Mavenclad and Ponvory

Metric	Mavenclad (cladribine)	Ponvory (ponesimod)
Generic name	Cladribine	Ponesimod
Indications	Multiple sclerosis (specifically relapsing forms)	Multiple sclerosis (specifically relapsing forms)
Mechanism of action	Purine analog that disrupts DNA synthesis and repair, leading to cell death, particularly in lymphocytes	S1P receptor modulator that prevents lymphocytes from exiting lymph nodes, reducing their migration into the CNS
Brand names	Mavenclad	Ponvory
Administrative route	Oral	Oral
Side effects	Lymphopenia, infections, liver enzyme elevations, hematologic abnormalities	Upper respiratory tract infections, elevated liver enzymes, high blood pressure, and transient decreases in heart rate
Contraindications	HIV infection, active chronic infections, hypersensitivity to cladribine	CYP3A4 inhibitors, recent (within 14 days) live attenuated vaccine administration, hypersensitivity to ponesimod
Drug class	Antimetabolite	Sphingosine 1-phosphate receptor modulator
Manufacturer	Merck	Janssen Pharmaceuticals

Efficacy

Mavenclad (Cladribine) Efficacy in Multiple Sclerosis

Mavenclad (cladribine) is an oral medication approved for the treatment of relapsing-remitting multiple sclerosis (RRMS) and active secondary progressive multiple sclerosis (SPMS) in adults. Clinical trials have demonstrated its efficacy in reducing the frequency of relapses and slowing down the progression of disability. In the CLARITY study, a pivotal phase III clinical trial, treatment with Mavenclad resulted in a significant reduction in annualized relapse rates (ARR) compared to placebo. Additionally, the trial showed a reduction in the number of lesions visible on MRI scans, indicating a decrease in disease activity.

Another important aspect of Mavenclad's efficacy is its dosing schedule, which involves a maximum of 20 days of treatment over two years. This short dosing regimen has been shown to have long-lasting effects on disease activity, with some patients experiencing prolonged periods of no evident disease activity (NEDA). The convenience of the dosing schedule, combined with its efficacy, makes Mavenclad a valuable treatment option for MS patients.

Ponvory (Ponesimod) Efficacy in Multiple Sclerosis

Ponvory (ponesimod) is an oral sphingosine-1-phosphate receptor modulator approved for the treatment of adults with relapsing forms of multiple sclerosis, including clinically isolated syndrome (CIS), relapsing-remitting disease (RRMS), and active secondary progressive disease (SPMS). In the phase III OPTIMUM study, ponesimod demonstrated superiority over teriflunomide, another oral MS therapy, in reducing the annualized relapse rate. Patients treated with Ponvory showed a 30.5% reduction in ARR compared to those receiving teriflunomide.

Beyond reducing relapse rates, Ponvory has also been found to be effective in slowing the progression of disability and reducing the number of new or enlarging MRI-detected lesions. The OPTIMUM study revealed that Ponvory led to a significant reduction in the number of combined unique active lesions (CUALs) on MRI scans. These results suggest that Ponvory can effectively control disease activity and may have a positive impact on the long-term outcomes for patients with MS.

Regulatory Agency Approvals

Mavenclad

European Medical Agency (EMA), European Union
Food and Drug Administration (FDA), USA
Health Canada
Therapeutic Goods Administration (TGA), Australia
Medsafe (NZ)

Ponvory

European Medical Agency (EMA), European Union
Food and Drug Administration (FDA), USA

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