Ozanimod

How it works

It selectively engages S1P1 and S1P5 receptors, trapping lymphocytes within lymph nodes and reducing the number of circulating lymphocytes available to enter the central nervous system.

Prescribing in practice

• Because it can cause bradycardia and AV conduction delay, a baseline ECG and cardiology review are needed in those with relevant cardiac disease, and dose initiation follows a gradual titration.
• Screening before starting must include full blood count, varicella-zoster immunity, liver function and an ophthalmological assessment for macular oedema risk.
• It is contraindicated with concomitant MAO inhibitors, and tyramine-rich foods should be limited because of an active metabolite with MAO-inhibitory properties.

Monitoring

Monitor full blood count, liver function, blood pressure and for signs of infection or macular oedema during treatment, with cardiac observation at initiation where indicated.

Counselling the patient

• Do not miss doses, as restarting may require repeating the gradual dose build-up.
• Report any visual disturbance, breathlessness, palpitations, or signs of infection promptly.
• Avoid live vaccines during and shortly after treatment, and tell your team if you plan to become pregnant.

Evidence & guidelines

The SUNBEAM and RADIANCE trials established its efficacy in relapsing MS, and it is recommended by NICE for relapsing-remitting disease and for ulcerative colitis.