Ponesimod (Ponvory)

Ponesimod (Ponvory) is a disease modifying therapy (DMT) for treating relapsing remitting MS. 

Disease modifying therapies (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.

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

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

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

Ponesimod is used for treating active relapsing remitting MS.

It can also be used to treat highly active relapsing remitting MS. RRMS is considered highly active if you continue to have relapses despite treatment with another DMT. 

You may therefore hear it referred to as an escalation therapy or second line treatment. 

Ponesimod is also licensed for treating clinically isolated syndrome (CIS) which fulfils the McDonald criteria for relapsing remitting MS. 

Ponesimod is licensed and approved for use by adults only. 

It can only be prescribed by a neurologist. 

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

Ponesimod 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 ponesimod reduces their ability to move freely, it affects some of your body’s immune responses, increasing your risk of infections.  
 

While 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%. 

Ponesimod is considered a moderately effective therapy. In clinical trials, it has been shown to reduce relapses by about 30%, compared to teriflunomide (Aubagio). Ponesimod sits at the higher end of the moderately effective category. 

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

It was not clear from the study how ponesimod affects disability progression. 

We have information about the benefits of DMTs.  

We also have more information about ponesimod research. We also have information about how new drugs are developed.  
 

Before you start taking ponesimod, 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 DMT.

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

Ponesimod 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
• issues with your heart, such as irregular or abnormal heartbeat (arrhythmia), unless you have a pacemaker 
• stroke or a mini stroke
• active cancer
• severe liver problems.

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

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

• heart problems, such as an irregular or slow heartbeat
• previous stroke (NHS UK) 
• fever or infection 
• a lowered immune response (due to certain conditions or because of medicines that you might be taking, which suppress your immune system) 
• breathing problems such as chronic obstructive pulmonary disease (COPD) (NHS UK) or pulmonary fibrosis (Asthma + Lung UK) 
• high blood pressure (NHS UK) 
• eye problems such as uveitis (NHS UK)  
• diabetes (NHS UK) – the risk of getting macular oedema (Macular Society) when being treated with ponesimod is increased if you have diabetes.

If you have any of the above and ponesimod is prescribed for you, you may need additional monitoring during treatment.

In some cases, your treatment with ponesimod may be delayed until the health issues are resolved.

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

It is especially important that you let them know about: 

• medicines to control your heart rhythm or heartbeat, such as beta blockers 
• medicines to control your blood pressure  
• medicines that affect your immune system. 

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

Taking ponesimod 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 ponesimod.

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

If you are already taking ponesimod and you start considering pregnancy, your MS team will discuss with you what is best for you. They are likely to recommend that you stop taking ponesimod and continue using effective contraception for 1 week after you stop taking it. 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 get pregnant while taking ponesimod, tell your MS team straight away. They will discuss with you what treatment may be best for you. 

Ponesimod is not recommended for women who are breastfeeding. 

Where appropriate, you may be given a pregnancy-specific patient reminder card (Health Products Regulatory Authority) PDF  when you start taking ponesimod.

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

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

• blood pressure measurement 
• an electrocardiogram (ECG) (NHS UK) 
• a full blood count (NHS UK) 
• liver blood tests (formerly LFT) (Liver UK)) 
• an eye examination 
• a pregnancy test – where appropriate tests to check your immunity against the virus that causes chickenpox (NHS UK) (varicella zoster virus). 

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

You take ponesimod as a pill, once daily.

Your neurologist will prescribe this, and you will be given a 14-day treatment initiation pack. This is usually delivered to your home through homecare, or you may get it from the hospital pharmacy if you need to be monitored when you take the first dose.

You will usually be started on a lower dose, which will be gradually increased to the full dose during the initial 14 days. This gives your body time to get used to the therapy and reduces the impact of any potential side effects.

You can also speak to your pharmacist or MS team if you are worried about missed doses. If you miss four or more doses in a row, it is important that you speak to your MS team before you restart treatment.

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

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

Your doctor may recommend monitoring when you first take ponesimod if you have certain heart conditions or take medicines such as beta blockers (NHS UK). 

Monitoring usually includes:

• blood pressure checks for at least 4 hours after the first dose 
• heart rate checks for at least 4 hours after the first dose 
• an electrocardiogram (ECG) (NHS UK) at the end of 4 hours.

If you still have a very slow or decreasing heart rate, your doctor may continue monitoring you until this is resolved. 

Monitoring usually takes place at home or in an outpatient clinic.
 

You should not stop taking ponesimod (Ponvory) without discussing it with your neurologist, as your MS may become more active after stopping treatment. 

If your neurologist has agreed for you to stop taking ponesimod, your MS symptoms may be worse than they were before. Speak to your neurologist if you are worried about your symptoms.
 

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 ponesimod include: 

• infection of the nose, throat or sinuses 
• increased liver enzyme levels.

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

• anxiety (NHS UK) 
• infections, including coughs, colds and chest infections 
• indigestion (dyspepsia) 
• shortness of breath (NHS UK) 
• insomnia (NHS UK) 
• urinary tract infections (UTI) (NHS UK) 
• macular oedema (Macular Society) - your risk is higher if you have diabetes (NHS UK).   

Uncommon side effects (may affect up to 1 in 100 people) can include: 

• slow heartbeat 
• swollen joints.

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

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 ponesimod. 
Cases have not been reported in people taking ponesimod. 
Symptoms of PRES include: 

• a sudden severe headache 
• sudden confusion 
• sudden loss of vision 
• sudden changes in your vision 
• seizure.

Call 999 or tell your MS team straight away if you notice any of these symptoms.

If you are worried about side effects before and 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 ponesimod. 

A full list of side effects is included 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 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 therapies (DMT).  

Because ponesimod suppresses your immune system, increasing your risk of infection, live vaccines will not be recommended for you. Live vaccines such as the yellow fever (NHS UK) and MMRV (NHS UK) vaccines should be avoided. 

If you receive a live vaccine, you may get the infection the vaccine was meant to prevent. It is therefore recommended that ponesimod is stopped 1 week before and for 4 weeks after you get a live vaccine. It is important that you speak to your MS team before you stop taking ponesimod.

Vaccines may not be as effective during treatment with ponesimod however non-live vaccines still help to protect you against infection. 

We have more information about vaccination and immunisation.  

You will usually have routine reviews to check that ponesimod 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 (formerly LFT) (Liver UK) 
• blood pressure checks 
• skin checks for any changes 
• eye examination 
• MRI scan.  

• Patient Information Leaflet - Ponvory
• Which DMTs are approved for use in the UK?
• Disease modifying drugs - book
• Disease modifying drugs: comparison chart

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: 

• Mavis Ayer, Multiple Sclerosis Lead Clinical Nurse Specialist, University Hospital Southamptoon NHS Foundation Trust
• Dr Claire McCarthy, Consultant Neurologist, Cambridge University Hospitals NHS Foundation Trust
• Kenneth Chu, Advanced Clinical Pharmacist for Multiple Sclerosis, Cambridge University Hospitals NHS Foundation Trust
• Dr Leonora Fisniku, Consultant Neurologist, Cambridge University Hospitals NHS Foundation Trust
• Dr Nick Cunniffe, Consultant Neurologist, Cambridge University Hospitals NHS Foundation Trust