Ozanimod

How it works

It selectively modulates S1P receptor subtypes 1 and 5, retaining lymphocytes within lymphoid tissue and reducing the migration of activated lymphocytes into the gut mucosa.

Prescribing in practice

• It can cause bradycardia and atrioventricular conduction delay on initiation, so a dose-titration schedule and baseline ECG are required, with cardiology advice in those with relevant cardiac disease.
• It is contraindicated with concomitant MAO inhibitors and requires caution with other agents lowering heart rate; tyramine-rich foods and certain co-medications can precipitate hypertensive reactions.
• Screen for prior varicella exposure and ensure immunisation status, ophthalmological assessment for macular oedema risk, and exclude active infection before starting.

Monitoring

Perform baseline ECG, full blood count, liver function and ophthalmic assessment, with blood pressure and liver monitoring during treatment.

Counselling the patient

• Follow the initial up-titration schedule exactly, as it limits the effect on your heart rate.
• Report palpitations, dizziness, visual disturbance, signs of infection or breathlessness.
• Effective contraception is needed during treatment and for a period after stopping.

Evidence & guidelines

Efficacy in ulcerative colitis was demonstrated in the True North trial and the agent is recommended within NICE technology appraisal guidance.