Ponvory (Ponesimod)

Description

Ponvory is a sphingosine-1-phosphate receptor modulator that helps manage multiple sclerosis (MS). This oral medication helps regulate the immune system and reduce inflammation by influencing certain types of white blood cells. Classified within a newer category of disease-modifying therapies, Ponvory offers a treatment option for adults with relapsing forms of MS, which include clinically isolated syndrome, relapsing-remitting MS, and active secondary progressive disease. It may help decrease the frequency of relapse episodes and slow down the progression of physical disability associated with MS.

Directions

Ponvory is typically started at a 2 mg dose on their first day, which is then gradually increased until they reach the standard daily dose of 20 mg by day 15. The pill should be taken at the same time each day, with or without food. If a dose is missed, consult the medication guide for instructions or contact a healthcare provider. Inform a healthcare provider of any new or worsening symptoms, such as dizziness or shortness of breath, which could indicate side effects like a slow heart rate.

Ingredients

Ponvory contains the active ingredient Ponesimod. Alongside the active substance, the tablet contains several inactive ingredients: croscarmellose sodium, lactose monohydrate, magnesium stearate, microcrystalline cellulose, povidone K30, silica colloidal anhydrous, and sodium lauryl sulfate.

Contraindications

Patients should not start Ponvory therapy if any of the following conditions are present:

• Recent cardiovascular events, including myocardial infarction, unstable angina, stroke, transient ischemic attack (TIA), or instances of decompensated heart failure that necessitated hospitalization, all occurring within the last 6 months
• Established diagnosis of advanced heart failure, specifically Class III or IV
• Known cardiac rhythm disorders such as Mobitz type II second-degree AV block, third-degree AV block, sick sinus syndrome, or sino-atrial block, unless the individual has a functioning pacemaker in place

Cautions

• Consult your healthcare provider about the following before starting treatment with Ponvory:
• Medication allergies
• Prescription and over-the-counter medications you may be taking
• Other medical conditions you have
• Whether you’re pregnant or breastfeeding
• Ponvory can increase the risk of infections. A complete blood count (CBC) is necessary to evaluate your health status before beginning treatment. Be vigilant for signs of infection both during treatment and for a couple of weeks after discontinuation. Avoid starting Ponvory if you currently have an active infection.
• Treatment with Ponvory may initially lead to a decrease in heart rate. This necessitates a dose increase over time when beginning the medication. An ECG is recommended to check for any existing cardiac issues. If you have heart rhythm problems or are on medications affecting your heart rate, consulting with a cardiologist might be advisable.
• Ponvory has the potential to impair lung function. Pulmonary function tests, such as spirometry, might be necessary if there are clinical indications of respiratory issues.
• While rare, Ponvory can cause significant liver injury. Liver function tests should be conducted prior to initiating treatment. If substantial liver injury is detected, discontinuation of Ponvory is recommended.
• During treatment with Ponvory, blood pressure may increase. Regular monitoring of blood pressure is important.
• Since there may be an increased risk of skin cancers with Ponvory, periodic skin examinations by a healthcare professional are recommended.
• Ponvory can be harmful to an unborn baby. Women who could become pregnant should use effective contraception while on Ponvory and for a week after discontinuing it.
• An eye examination is advised before starting Ponvory and if any vision changes occur during treatment. Those with diabetes or uveitis are at a higher risk for macular edema.

Side Effects

Like other medications, Ponvory may cause side effects. The most common Ponvory side effects include upper respiratory tract infections, abnormal liver tests indicating elevated liver enzymes, and high blood pressure.

Ponvory carries a risk of serious infections due to its effects on white blood cell counts, which can be life-threatening. Symptoms to watch for are fever, body aches, chills, nausea, vomiting, and signs of meningitis like headache with fever and neck stiffness. Treatment may be adjusted if an infection occurs. Additionally, Ponvory can cause a slow heart rate, especially after the first dose. Signs of this include dizziness, lightheadedness, and chest pain. Patients are advised to have heart function tests before starting and to seek immediate medical attention for any serious symptoms.

References:

1. Ponvory (Ponesimod) Product Monograph. Titusville, NJ: Janssen Pharmaceuticals; 2021.
2. Ponvory (Ponesimod) Drug Label Information. Titusville, NJ: Janssen Pharmaceuticals; 2021.

About Dr. Gerardo Sison (Page Author)

An honors graduate of the University of Florida, Dr. Sison started his pharmacy career in a community setting, extending his services to hospitals and clinics over time. He has also worked in medication therapy management, advising patients on proper medication use for their chronic health conditions. Read More....