Post-Authorization Safety Study for Assessment of Pregnancy Outcomes in Patients Treated With Mayzent

Inclusion Criteria:

Participants must meet all the criteria listed under the respective cohorts to enroll in
that particular cohort of the registry:

Cohort 1: Siponimod-Exposed Cohort

1. Pregnant women

2. Diagnosed with MS, with the indication validated by medical records when possible

3. Exposure to siponimod for the treatment of MS, for any number of days, at any dose,
and at any time from the 4th day post the first day of LMP prior to conception up to
and including the end of pregnancy

4. Agree to the conditions and requirements of the study including the interview
schedule, release of medical records, the dysmorphology examination of live born
infants, and the Ages and Stages Questionnaire (ASQ) in live born children

Cohort 2: Disease-Matched Comparison Cohort (Comparison Group 1)

1. Pregnant women

2. Diagnosed with MS, with the indication validated by medical records when possible

3. May or may not have taken another medication for MS in the current pregnancy

4. Agree to the conditions and requirements of the study including the interview
schedule, release of medical records, the dysmorphology examination of live born
infants, and the ASQ in live born children

Cohort 3: Healthy Comparison Cohort (Comparison Group 2):

1. Pregnant women

2. Agree to the conditions and requirements of the study including the interview
schedule, release of medical records, the dysmorphology examination of live born
infants, and the ASQ in live born children

Exclusion Criteria:

Women meeting any of the following criteria will be excluded from the cohort study:

Cohort 1: Siponimod-Exposed Cohort

1. Women who have enrolled in the siponimod cohort study with a previous pregnancy

2. Women who have used siponimod for an indication other than a currently approved
indication

3. Women with exposure to any of the following medications within 5 half-lives prior to
conception:

- Cladribine (Mavenclad)

- Based on the US label, animal studies indicate that there is positive evidence
of teratogenicity for Cladribine

- All other S1P modulators including fingolimod (Gilenya), ozanimod, etc.

- S1P modulatros are in the same class of drug as siponimod

- Teriflunomide (Aubagio)

- The teratogenicity of teriflunomide is unknown and currently under
investigation

- Other anti-CD20 monoclonal antibody: same class as Kesimpta

- New medications (marketed after 2020) indicated for the treatment of MS will be
evaluated for inclusion/exclusion criteria as the study progresses.

4. Retrospective enrollment after the outcome of pregnancy is known (i.e. the pregnancy
has ended prior to enrollment)

5. Results of a diagnostic test are positive for a major structural defect prior to
enrollment. However, women who have had any normal or abnormal prenatal screening or
diagnostic test prior to enrollment are eligible as long as the test result does not
indicate a major structural defect.

Cohort 2: Disease-Matched Comparison Cohort (Comparison Group 1):

1. Exposure to siponimod any time from the 4th day post the first day of LMP prior to
conception up to and including end of pregnancy

2. Women with exposure to any of the following medications within 5 half-lives of
conception:

- Cladribine (Mavenclad)

- S1P modulators

- Teriflunomide (Aubagio)

- Anti CD-20 monoclonal antibody New medications (marketed after 2020) indicated
for the treatment of MS will be evaluated for inclusion/exclusion criteria as
the study progresses.

3. Women who have enrolled in the siponimod cohort or OMB157G2403 Kesimpta cohort with
a previous pregnancy

4. Retrospective enrollment after the outcome of pregnancy is known (i.e. the pregnancy
has ended prior to enrollment)

5. Results of a diagnostic test are positive for a major structural defect prior to
enrollment. However, women who have had any normal or abnormal prenatal screening or
diagnostic test prior to enrollment are eligible as long as the test result does not
indicate a major structural defect.

Cohort 3: Healthy Comparison Cohort (Comparison Group 2):

1. Exposure to Kesimpta 166 days before or to siponimod any time from the 4th day post
first day of LMP prior to conception to and including end of pregnancy

2. Women who have a diagnosis of a MS or a siponimod approved indication

3. Women who have a current diagnosis of any autoimmune disease

4. Women who have first contact with the project after prenatal diagnosis of any major
structural defect

5. Women who have enrolled in the siponimod cohort or Kesimpta cohort study with a
previous pregnancy

6. Women treated with Mayzent or Kesimpta for non-MS indication

7. Retrospective enrollment after the outcome of pregnancy is known (i.e. the pregnancy
has ended prior to enrollment)

8. Results of a diagnostic test are positive for a major structural defect prior to
enrollment. However, women who have had any normal or abnormal prenatal screening or
diagnostic test prior to enrollment are eligible as long as the test result does not
indicate a major structural defect.

9. Women exposed to a known human teratogen during pregnancy as confirmed by the OTIS
Research Center