MS- Ozonimod DI

Question 1

Ozonimod brand name

Answer 1

Zeposia

Trick: (oZonimod, Zeposia- both have a Z in it!)

Question 2

Ozonimod indications

Answer 2

CIS, active SPMS, RRMS

Question 3

Ozonimod MoA

Answer 3

Same MoA as siponimod.Mayzent (high affinity to SP1 receptors 1 and 5)

Question 4

Ozonimod initial dosing

Answer 4

0.23mg PO QD on days 1-4, then 0.46mg PO QD on days 5-7

Question 5

Ozonimod maintenance dosing

Answer 5

0.92mg PO QD starting on day 8

Question 6

What to do if you miss an ozonimod dose

Answer 6

If it’s during the titration phase, start over at 0.23mg.
If it’s after the titration phase, you can just continue on as normal

Question 7

Warnings and precautions of ozonimod

Answer 7

Same as the other SP1 modulators:

AV block, bradycardia, hepatotoxicity, HTN, infections, lymphopenia, macular edema, neurotoxicity, PML, respiratory effects, varicella zoster infections

Question 8

ADEs of ozonimod

Answer 8

Infection, URTIs, HTN, upper abdominal pain, UTI, lymphocytopenia, increased serum alanine aminotransferase, increased serum transaminases, back pain

Question 9

DDIs with ozonimod

Answer 9

immunosuppressants, 2C8 inducers/inhibitors, bradycardia-causing agents, QTc prolonging agents, MAOIs, drugs affecting BCRP, tobacco, vaccines

Question 10

Ozonimod metabolism

Answer 10

substrate of BCRP, major substrate of 2C8, minor substrate of 3A4

Question 11

What kind of food should you avoid when taking ozonimod?

Answer 11

TYRAMINE-CONTAINING FOODS, IT INCREASES THE RISK FOR HTN CRISIS

Question 12

Live vaccines and ozonimod

Answer 12

If live vaccines are given before treatment starts, start the therapy 1 month after immunization

Question 13

Ozonimod CIs

Answer 13

Basically anything related to heart issues:

MI, unstable angina, stroke, TIA, decompensated HF requiring hospitalization, Class III or IV HF in the last 6 months; Mobitz type II second or third-degree AV block, sick sinus syndrome, sinoatrial block unless patient has functioning pacemaker, severe untreated sleep apnea, concomitant use of MAOI

Question 14

Ozonimod monitoring

Answer 14

CBC with lymphocyte counts
Baseline bilirubin and transaminase levels
Baseline ECG, BP
Bradycardia
Eye exam
VZV antibodies
Signs/symptoms of infection during treatment and at least 4 weeks after D/C
Severe increase in disability following D/C

Question 15

Ozonimod half-life

Answer 15

21 hours

Question 16

Half-life of ozonimod’s metabolites

Answer 16

11 DAYS

Question 17

Time to peak of ozonimod

Answer 17

6-8 hours

Question 18

What doesn’t ozonimod need compared to fingolimod and simponimod?

Answer 18

FIRST DOSE OBSERVATION!!