Is there a big difference in the underlying biology? To my knowledge, the answer is probably not. Rather, the main difference is one of terminology—SPMS patients are sicker (they don’t relapse) and hence more difficult to treat.
I’m skeptical of the claim that a drug works in SPMS but not in RRMS. (The reverse claim—that a drug works in RRMS but not in SPMS— makes more sense.)
Moreover, the PR from BioMS is bearish in regard to LLY’s assessment of the program:
BioMS and its partner Eli Lilly & Company (Lilly) will continue to analyze the results of this exploratory phase II trial.
As you well know, this is about the least encouraging thing a company can say in this kind of PR. Notably absent is any assertion that LLY remains fully committed to the program.
“The efficient-market hypothesis may be the foremost piece of B.S. ever promulgated in any area of human knowledge!”