Ozanimod (Zeposia)

Ozanimod (Zeposia) is a disease modifying therapy (DMT) for treating relapsing remitting MS. 

DMTs are treatments for people with multiple sclerosis (MS) that can help change the course of your MS by reducing the number of relapses and slowing down the buildup of disability in the long term.

They are for people whose MS is considered active. This means you’re getting relapses or you have new or enlarging lesions on an MRI scan. 

Ozanimod, which is sold under the brand name Zeposia, is available as a pill that is taken once a day. 

In the UK, ozanimod is approved for use on the NHS in Scotland only. 

On this page, we look at who can take ozanimod, how it works, its benefits and possible side effects. 

Ozanimod is used for treating active relapsing remitting MS. Ozanimod is licensed and approved for use by adults only. 

Only a neurologist can prescribe it. 

We have information about other DMTs for treating relapsing remitting MS and progressive MS. 

Ozanimod helps to protect your brain and spinal cord (central nervous system) against attacks from the immune system. It does this by reducing the ability of some white blood cells (lymphocytes) to move freely within the body, stopping them from reaching the brain and spinal cord. This limits nerve damage caused by MS. 

White blood cells help your body fight infections. Because ozanimod reduces their ability to move freely, it affects some of your body’s immune responses, increasing your risk of infections.

While disease modifying therapies (DMTs)  cannot cure MS, they have several benefits, such as reducing the number of relapses you may have. 

The DMTs for treating relapsing remitting MS (RRMS) are grouped according to how effective they are (efficacy) at reducing the number of relapses you may have. 

The therapies are described as:

• moderately effective therapies – these reduce relapses by up to 50% 
• highly effective therapies – these reduce relapses by more than 50%.  

Ozanimod is a moderately effective therapy. In clinical trials, ozanimod has been shown to reduce relapses by between 38% to 48% when compared with a beta interferon (Avonex). Ozanimod sits at the higher end of the moderately effective category.

MRI scans also showed that people taking ozanimod had fewer, smaller or no new areas of active MS (lesions). 

It is unclear what ozanimod’s effect on disability progression is. 

We have more information about the benefits of DMTs and how new drugs are developed.

Before you start taking ozanimod, your MS team will discuss the benefits and possible risks of the therapy with you. 

Together, you will decide if the benefits outweigh any potential risks based on your circumstances. You will consider several factors. 

We have more information about starting a disease modifying therapy (DMT). 

Ozanimod is not suitable for some people. It is important that you tell your MS team if you have any health issues or are taking other prescribed or unprescribed medicines. 

Ozanimod will not be recommended for you if you have, or have had, certain health issues or conditions, such as: 

• a severely weakened immune system 
• a heart attack or certain types of heart failure in the last 6 months 
• stroke (NHS.UK) or a mini stroke in the last 6 months 
• issues with your heart, such as irregular or abnormal heartbeats (arrhythmia (NHS.UK)) 
• severe infection such as hepatitis (NHS.UK) or tuberclosis (TB) (NHS.UK) 
• cancer 
• severe liver problems.

It will also not be recommended for you if you are allergic to ozanimod or any of the other ingredients it contains. 

Other health issues your MS team may consider when deciding if ozanimod is suitable for you include: 

• slow heart rate or if you are taking, or have recently taken, medicines that slow your heart rate, such as beta blockers (NHS.UK)
• untreated severe breathing problems when you sleep (severe sleep apnoea (NHS.UK))  
• problems with your liver 
• problems with your eyes, such as macular oedema (Macular Society) or uveitis (NHS.UK) 
• diabetes (NHS.UK)
• severe lung disease, such as chronic obstructive pulmonary disease (COPD) (NHS.UK) 
• recent vaccination or if you are planning to have a vaccination 
• if you have never had, or are not sure if you have had chickenpox (NHS.UK).

If you have or have had any of the above and you are prescribed ozanimod, you may need additional monitoring during treatment.

Let your neurologist know if you are taking, or have recently taken, other prescribed or unprescribed medicines, vitamins or supplements. 

Medicines your MS team will consider when assessing whether ozanimod is suitable for you include: 

• medicines that affect your immune system 
• antibiotics for treating tuberclosis (TB) (NHS.UK) and other serious infections 
• some medicines for treating depression (NHS.UK). 

You can find out more about health issues to consider before you start taking ozanimod (EMC patient information leaflet). 

Taking ozanimod when pregnant can harm your unborn baby. It will not be recommended if you are considering having a baby. 

The use of effective contraception is recommended while you are taking ozanimod.

If you’re considering taking ozanimod or any other disease modifying therapies (DMT), your MS team will proactively discuss family planning and the possibility of pregnancy with you where appropriate.

If you are already taking ozanimod and you start considering pregnancy, your MS team will discuss with you what’s best for you. They are likely to recommend that you stop taking it and continue using effective contraception for 3 months after you stop. This is to ensure that blood levels of the therapy are low enough for it to be safe to become pregnant. You may hear this referred to as a washout period. 

If you become pregnant while taking ozanimod, tell your MS team straight away. They will discuss with you what treatment may be best for you and how to stop ozanimod safely. 

Ozanimod is not recommended for women who are breastfeeding. 

Where appropriate, you may be given a pregnancy-specific patient reminder card (EMC) when you start taking ozanimod.

We have general information about starting a DMT and things to consider. 

Before starting ozanimod, you will have tests to determine if it is suitable for you. These include: 

• an electrocardiogram (ECG) (NHS.UK) 
• a full blood count (NHS.UK)
• liver blood tests (formerly LFT) (British Liver Trust) 
• an eye examination 
• a pregnancy test – where appropriate.

If you are not protected against chickenpox (NHS.UK), it is usually recommended that you get a chickenpox vaccine (NHS.UK) before you start taking ozanimod. You will usually need to get this at least 4 weeks before you start treatment. 

You take ozanimod as a pill, once daily.

Your neurologist will prescribe it, and you will be given a 7-day treatment initiation pack. 

You will usually start on a low dose, which is gradually increased to the full dose over the first 7 days. This helps reduce any potential effect of slowing your heart rate. 

The patient information leaflet has information about starting ozanimod and what to do if you miss a dose (EMC)

You can also speak to your pharmacist or MS team if you are worried about missed doses. 

Ozanimod can slow down your heart rate – especially after the first dose.

Your doctor may recommend monitoring when you first take ozanimod if you have certain heart conditions. 

Monitoring will usually involve having an electrocardiogram (ECG) (NHS.UK) before you take the first dose and after 6 hours.

You should not stop taking ozanimod without discussing it with your neurologist first, as stopping may mean your MS symptoms may be worse than they were before. If ozanimod is no longer the right treatment for you, your MS team will work with you to plan a safe way to stop taking it. They will also work with you to find an alternative treatment. 

Ozanimod can stay in your body for up to 3 months after you stop taking it. If you were getting side effects, these may continue during this period.

All medicines, including disease modifying therapies (DMTs), can potentially cause side effects.

Some people may not experience side effects from taking a DMT. Some may find that any side effects ease after the first month or two as their body adapts to the medicine. For others, side effects may persist.

Your MS team will discuss potential side effects of the treatment with you and help you understand your risk. They will also tell you how to manage and report any side effects.

Very common side effects (may affect more than 1 in 10 people) of ozanimod include: 

• infection of the nose, throat or sinuses 
• low level of a type of white blood cell called lymphocytes. 

Common side effects (may affect up to 1 in 10 people) of ozanimod include: 

• slow heart rate 
• sore throat 
• respiratory tract infections (RTIs) (NHS.UK) 
• cold sores (NHS.UK) 
• headache 
• a drop or increase in blood pressure 
• urinary tract infections (UTIs)  
• swelling, especially of the ankles and feet (oedema) (NHS.UK) 
• skin or whites of the eyes turning yellow (jaundice) (NHS.UK) 
• increased liver enzyme levels 
• breathlessness. 

Uncommon side effects (may affect up to 1 in 100 people) can include:
•    allergic reactions
•    macular oedema (Macular Society).

A small number of skin cancer (Cancer Research UK) cases were reported in people taking ozanimod during clinical trials. Your MS team will tell you what skin changes to look out for before you start taking ozanimod and how to report any changes. They will also talk to you about precautions to take, such as protecting your skin. You will be monitored for changes while taking ozanimod.

Cases of a very rare but potentially serious condition called PRES (posterior reversible encephalopathy syndrome) have been reported in people taking medicines which act similarly to ozanimod. 

Cases of a rare but serious brain infection called progressive multifocal leukoencephalopathy (PML) have been reported in some people taking ozanimod. 

This is rare with roughly 1 in 1,000 people affected. Your MS team will help you understand your risk before you start taking ozanimod. If you are at increased risk of developing PML, you will be routinely monitored for signs and symptoms. 

Early signs and symptoms of PML can be like an MS relapse. It is important to tell your MS team straight away if you notice new or worsening symptoms of your MS.

If you are worried about side effects before or during treatment, you should tell your MS team straight away. You can also speak to a pharmacist if you have concerns. 

You will be regularly monitored when taking ozanimod. 

You can find a full list of side effects in the manufacturer's Patient Information Leaflet (EMC).

You can also report side effects through the Yellow Card scheme (MHRA). Reporting side effects can make a big difference to other people using the same medicine as you. 

People with MS are generally encouraged to have vaccinations which are part of the national vaccinations programme (NHS UK vaccinations). Where possible, your MS team will advise you to get relevant vaccinations before you start taking a disease modifying therapy (DMT). 

Because ozanimod suppresses your immune system, increasing your risk of infection, live vaccines will not be recommended for you. You should avoid live vaccines, such as the yellow fever vaccine while taking ozanimod and for 3 months after you stop taking it. 

You can have non-live vaccines during treatment with ozanimod. 

We have more information about vaccination and immunisation.

You will usually have routine reviews to check that ozanimod is effective and suitable for you once you start treatment. 

These checks will include some of the following at different intervals: 

• full blood count (NHS.UK) 
• liver blood tests (formally LFT) (British Liver Trust) 
• blood pressure checks 
• skin checks for any changes 
• eye examination if you have diabetes (NHS.UK) or a history of eye conditions such as uveitis (NHS.UK) 
• MRI scan. 

• Patient information leaflet - Zeposia
• Which DMTs are approved for use in the UK?

This information has been developed by the MS Trust Health Information team. Our team produces accurate evidence-based information to help you navigate your every day – working alongside health professionals. We would like to thank the following health professionals for checking the clinical accuracy of this information:

• Stavroula Charisi, MS Specialist Pharmacist, University Hospital Southampton NHS Foundation Trust
• Chammi (Deva) Karunathilaka, MS Nurse Specialist, Royal Free London NHS Foundation Trust
• Nicholas Cunniffe, Consultant Neurologist, Cambridge University Hospitals NHS Foundation Trust.