Ponesimod

How it works

It selectively binds the S1P1 receptor on lymphocytes, retaining them in lymphoid tissue and reducing the circulating lymphocytes that drive central nervous system inflammation.

Prescribing in practice

• It can cause a transient fall in heart rate and AV conduction delay at initiation, so a gradual up-titration starter pack is used and cardiac assessment is needed where heart disease is present.
• Baseline checks should include full blood count, liver function, varicella-zoster immunity, blood pressure and ophthalmic review for macular oedema risk.
• Missing several consecutive doses requires restarting with the titration regimen, and live vaccines should be avoided during and after treatment.

Monitoring

Monitor full blood count, liver function, blood pressure, and for infection, breathlessness, or visual disturbance during therapy.

Counselling the patient

• Do not miss doses; if you stop for several days you may need to restart with the gradual build-up pack.
• Report any breathlessness, palpitations, visual changes, or signs of infection.
• Avoid live vaccines and tell your team if you are planning a pregnancy.

Evidence & guidelines

The OPTIMUM trial showed lower annualised relapse rates versus teriflunomide, and NICE recommends it as an option for active relapsing-remitting MS.