Ponesimod oral therapy for the treatment of relapsing forms of multiple sclerosis in adults and its precautions in cardiovascular disease patients

The ponesimod oral therapy was approved in March 2021 by the United States Food and Drug Administration for relapsing forms multiple sclerosis (MS). Ponesimod is a sphingosine 1-phosphate (S1P) receptor 1 modulator that acts selectively as an anti- inflammatory agent and provides a suitable microenvironment for the function of the other neuroprotective agents. Ponesimod is contraindicated in patients who in the last 6 months, have experienced myocardial infarction, unstable angina, stroke, transient ischemic attack (TIA), decompensated heart failure requiring hospitalization, or Class III or IV heart failure. Also contraindicated in patients who have the presence of Mobitz type II second-degree, third-degree atrioventricular (AV) block, sick sinus syndrome, or sino-atrial block, unless the patient has a functioning pacemaker. This article briefs the information about dosage, precautions and warnings required in cardiovascular disease patients before initiation of ponesimod oral therapy.