Zeposia

Zeposia (ozanimod) is an oral medication for the treatment of relapsing-remitting and active secondary progressive multiple sclerosis.  This once-a-day medication works via S1P receptors, resulting in storage of certain types of lymphocytes (type of white blood cells) in lymph nodes preventing immune attack in brain and spinal cord.  This class of medication may also have positive benefits on cells within the brain and spinal cord which also have S1P receptors.

In the RADIANCE Trial, 1320 patients were randomized to ozanimod 0.5 mg, ozanimod 1 mg or Avonex.  Over 24 months, those patients on ozanimod 1 mg had 38% less relapses than those on the interferon Avonex.  New and enlarging T2 MRI lesions were reduced 42% and contrast active lesions reduced 53% vs. Avonex.  In the SUNBEAM Trial,  1346 participants were also randomly assigned to ozanimod 0.5 mg, ozanimod 1.0 mg or Avonex.  Ozanimod 1 mg treatment MS patients had 48% reduction in relapses,  had a 48% reduction in T2 lesions and 63% reduction in contrast enhancing lesions compared to Avonex.  In a planned analysis, ozanimod was not statistically better than Avonex is slowing down disability progression when combining patients from both trials.  In both trials, ozanimod was better than Avonex at preserving brain volume including the grey matter.

Side effects more common on Zeposia than Avonex included upper respiratory infections (nasopharyngitis), liver enzyme abnormalities and hypertension.  S1P medications have been associated with macular edema (swelling in back of eye) although infrequent in the ozanimod trials.  Rare potential risk of this class of medications are cryptococcal (fungal) meningitis and PML, a potential fatal brain infection.