Primary Risk Drivers
Below is a snapshot of domains that materially influence the MARA Rating.
Clinical effectiveness
Ponesimod shows moderate clinical effectiveness, with evidence indicating a statistically significant reduction in annualized relapse rates compared to teriflunomide. However, the effects on disability progression remain uncertain, which limits the overall assessment of its therapeutic impact.
Cost effectiveness
The cost-effectiveness estimates for ponesimod are below what NICE typically considers acceptable, indicating marginal cost-effectiveness. However, the committee acknowledged the uncertainty in the estimates due to limitations in the clinical evidence and model structure.
Quality of life
The treatment has shown potential benefits in reducing fatigue-related symptoms, which is an important aspect of HRQoL for patients with multiple sclerosis. However, the economic model did not explicitly include fatigue as an outcome measure, which may underrepresent its impact on quality of life.
Supporting Domains
Safety and Adverse Effects
Ponesimod has a safety profile comparable to other disease-modifying treatments, with all appropriate safety evidence considered. While there are concerns about serious adverse events, the overall tolerability appears acceptable.
Comparator Selection
The treatment was compared against a comprehensive range of relevant comparators, including both first- and second-line treatments for relapsing-remitting multiple sclerosis, which aligns well with clinical practice.
Patient Population and Subgroups
The trial population is broadly representative of the intended patient population with relapsing-remitting multiple sclerosis, and the inclusion criteria were appropriate for decision-making.
Care Pathway Integration
Ponesimod can be integrated into existing care pathways with manageable adjustments, as it is an oral treatment that does not require significant changes to current practices.
Resource Use and Cost Implications
While the treatment is expected to have a manageable budget impact, there are concerns about the overall resource burden, particularly given the uncertainties in cost-effectiveness estimates.
Evidence Quality and Robustness
The evidence base includes a mix of phase 2 and phase 3 trials, but there are notable limitations and uncertainties in the clinical data, particularly regarding long-term outcomes and the network meta-analysis.
Uncertainty, Sensitivity, and Broader Impacts
There is significant uncertainty regarding the treatment’s long-term effectiveness and cost-effectiveness, which may limit its broader acceptance and use in clinical practice.
