5 Frequently Asked Questions About Ponvory, a Medication for Multiple Sclerosis

Multiple sclerosis (MS) is an autoimmune disorder that causes your immune system to attack your nerves. It currently impacts almost 1 million adults across the U.S. Medication regimens used to treat MS vary widely, are often unique and tailored to each person, and can include injection, infusion, and oral options.

In March 2021, the FDA approved an oral medication called Ponvory (ponesimod) for adults with relapsing MS. It made headlines at the time of its approval within the MS community because clinical trials suggested that it worked better than some of the other options that were on the market.

If you’ve recently been prescribed Ponvory, it’s normal to have questions about it. How does it work? When will it kick in? Here, you’ll find the answers to five frequently asked questions about taking Ponvory for MS.

1. How does Ponvory work for MS?

Ponvory belongs to a group of medications known as sphingosine 1-phosphate (S1P) receptor modulators. Ponvory works for MS by attaching to S1P receptors (chemical binding sites) in your body. It’s thought that this tells your body to stop sending white blood cells (immune cells) to your nervous system. Fewer white blood cells around your nerves means less nerve damage.

One unique thing about Ponvory is that it only attaches to certain S1P receptors. This may help it have milder side effects than other, less selective medications in this class. However, more studies are needed to confirm if this is true.

2. What’s the recommended dosage for Ponvory?

Ponvory should be taken by mouth once a day around the same time every day. You can take it with or without food, but Ponvory must be swallowed whole. If you have trouble swallowing pills, let your healthcare provider know. This medication may not be the best option for you.

You will start with a very low dosage of Ponvory (2 mg per day) and work your way up. This is called dose titration. Slowly increasing your dose helps lower the risk of experiencing a severely low heart rate (a serious side effect). Your dosage will gradually increase over the course of 2 weeks until you’re taking 20 mg once a day. This is the target daily dosage.

You’ll likely receive your first dose of Ponvory at your healthcare provider’s office or other similar setting. They’ll monitor your heart rate for 4 hours after you take your dose. Depending on your response, your provider may suggest additional monitoring.

Good to know: If you miss four or more doses of Ponvory in a row, it’s recommended to restart the dose titration again. This is true even if you’ve been taking Ponvory for a while. Contact your provider or pharmacist if you miss doses. They can provide you with specific guidance for your situation.

3. Is it safe to take Ponvory?

For many people, the benefits outweigh the risks when it comes to taking Ponvory for relapsing MS. But it’s important to know about the medication’s possible side effects and warnings.

Common Ponvory side effects include:

• Upper respiratory infections, such as the common cold

• Elevated liver enzymes (a marker of liver function)

• Raised blood pressure

• Urinary tract infections (UTIs)

• Trouble breathing

• Dizziness

For most people, Ponvory’s side effects can be managed at home. They’re also typically reversible if you need to stop the medication. For instance, if Ponvory affects your liver enzymes, these levels should return to normal about 2 to 4 weeks after stopping the medication. But it’s best to ask your healthcare provider before stopping Ponvory on your own.

Rarely, Ponvory can also cause severe side effects, including:

• Serious infections, such as meningitis

• A very low heart rate

• Heart rhythm issues

• Severe breathing troubles

• Liver damage

• Severe high blood pressure

• Certain types of skin cancer

This isn’t a full list of all possible Ponvory side effects. Discuss your unique risks for side effects with your provider before starting the medication. They can tell you what to do if you think you’re experiencing a severe or bothersome side effect.

4. Does Ponvory interact with other medications?

Yes, Ponvory interacts with a number of other medications. Providing an updated medication list to your healthcare provider and pharmacist can help them better spot and manage these interactions.

Ponvory works by suppressing (weakening) certain immune cells. Taking other medications that can weaken your immune system, including corticosteroids such as prednisone, can raise your risk for serious infections. It’s typically best to take this combination with caution or avoid it if possible.

Certain heart medications, such as amiodarone (Pacerone), also interact with Ponvory. They raise your risk of a heart rhythm problem called long QT syndrome. While rare, this issue can be life-threatening.

Beta blockers, such as atenolol (Tenormin), also interfere with Ponvory. Beta blockers work by lowering your heart rate. This combination can raise your risk of having a severely low heart rate while taking Ponvory.

Live vaccines, such as the measles-mumps-rubella (MMR) vaccine and nasal flu vaccine, should be avoided while you’re taking Ponvory. There is a risk that you could get sick from live vaccines because of Ponvory’s immune system effects. It’s best to make sure you’re up to date with any recommended live vaccines before starting Ponvory.

Good to know: Inactivated vaccines, such as the injectable flu shot, are safe to receive while taking Ponvory. It’s also safe to receive mRNA vaccines, such as the COVID-19 vaccine. But they may be less effective.

5. How does Ponvory compare to Aubagio?

Some studies suggest Ponvory may be more effective than Aubagio (teriflunomide), a different oral medication for relapsing MS. But more head-to-head studies are needed to confirm this.

In April 2020, results from Ponvory’s phase 3 clinical trial — the last stage before a manufacturer can typically seek FDA approval — were published. Ponvory was compared to Aubagio. People in this study were followed for 2 years to see how many relapses they had during that time.

The results showed that 71% of those taking Ponvory had no MS relapses during those 2 years, compared to 61% of those taking Aubagio. This was considered to be a significant difference, meaning that Ponvory prevented flare-ups better than Aubagio. Additionally, people taking Ponvory experience fewer new brain lesions than those taking Aubagio. It was also noted that the amount of side effects experienced was similar regardless of which medication people took.

How to save on Ponvory

There are ways to save on Ponvory, which is only available as a brand-name medication. GoodRx can help you navigate between patient assistance programs and copay savings cards to save money on your prescription.

• Save with a copay savings card. If you have commercial insurance, you may be eligible to pay as little as $0 for Ponvory using a savings card from the manufacturer.

• Save with a patient assistance program. If you’re uninsured or underinsured, you may be eligible for Ponvory’s patient assistance program, which offers the medication free of cost.

Why trust our experts?

Written by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Our editorial standards

Meet our experts