Zeposia (ozanimod) for multiple sclerosis

Last updated Sept. 12, 2025, by Andrea Lobo, PhD
Fact-checked by Inês Martins, PhD

What is Zeposia for MS?

Zeposia (ozanimod) is an oral medication that is approved for adults with relapsing forms of multiple sclerosis (MS), including clinically isolated syndrome (CIS), relapsing-remitting MS (RRMS), and active secondary progressive MS (SPMS).

Marketed by Bristol Myers Squibb, Zeposia has been shown to reduce relapse rates and the development of new lesions in clinical trials. The therapy is taken as a once-daily capsule.

Zeposia works by inhibiting sphingosine 1-phosphate (S1P) receptors, which control the migration of immune cells from lymph nodes — organs where some immune cells are matured and stored — to the blood. By binding to S1P protein receptors on immune cells, Zeposia “traps” them inside lymph nodes, preventing these cells from getting into the brain and spinal cord, where they could cause damage.

As S1P receptors are also found in nervous system cells, Zeposia may promote the survival and growth of these cells, potentially supporting nervous system health.

Zeposia is also approved in the U.S. for adults with ulcerative colitis, an inflammatory bowel disease.

Therapy Snapshot

Who can take Zeposia?

Zeposia is approved in the U.S. for adults with CIS, RRMS, and active SPMS.

The medication is contraindicated, or not suggested for use, in people:

• who experienced certain cardiovascular problems in the last six months, such as a heart attack, some forms of chest pain (unstable angina), stroke or mini-stroke, or certain types of heart failure
• with certain types of heart block or abnormal heart rhythms, unless they have a functioning pacemaker
• with severe untreated sleep apnea, a sleeping disorder
• who are receiving treatment with a class of antidepressants called monoamine oxidase inhibitors.

Zeposia is also approved in dozens of other countries, but indications may differ. In the European Union and Canada, for example, the medication is only approved for people with RRMS.

How is Zeposia administered?

Zeposia comes in the form of oral capsules, which can be taken with or without food, preferably at the same time each day.

The recommended dose is 0.92 mg, taken once a day. However, treatment typically starts at a lower dose and gradually increases to the full maintenance dose over the first eight days.

A seven-day starter pack is available for those initiating the therapy for the first time and for those who miss at least one dose during the first two weeks of treatment. Following the titration period, dose adjustments may be needed for people with liver impairment.

Zeposia in clinical trials

Zeposia’s approval in the U.S. was largely supported by data from two Phase 3 clinical trials involving more than 2,600 adults with RRMS and active SPMS. Both trials tested Zeposia against Avonex (interferon beta-1a), an approved therapy for relapsing forms of MS.

• Data from the RADIANCE trial (NCT02047734), which treated patients for two years, showed that the approved dose of Zeposia significantly reduced relapse rates by 38%, with 76% of patients having no relapses compared with 64% with Avonex. The number of new or enlarging lesions and active lesions was also reduced by 42% and 53%, respectively.
• The SUNBEAM trial (NCT02294058), which treated patients with Zeposia or Avonex for at least one year, showed similar results. Participants who received the approved dose of Zeposia had a 48% reduction in both relapse rates and new or enlarging lesions. The rates of inflammatory lesions were also reduced by 63%, compared with Avonex.

A pooled analysis of both trials found no significant differences in the proportion of patients with confirmed disability progression, with 90% of patients in both groups showing no disability progression. However, brain volume loss was lowered with Zeposia, indicating slower nerve cell loss.

Zeposia side effects

The most common side effects of Zeposia reported in MS clinical trials include:

• upper respiratory tract infection
• elevated levels of liver enzymes, indicating liver damage
• an unusual drop in blood pressure upon standing, called orthostatic hypotension
• urinary tract infection
• back pain
• high blood pressure

Other side effects associated with Zeposia, which may be serious, include:

• infections, including progressive multifocal leukoencephalopathy, a potentially fatal brain infection
• temporary changes in heart rate and rhythm
• liver damage, which may lead to liver failure and require a transplant
• reduced lung function
• swelling in the back part of the eye, which can lead to permanent vision loss
• skin cancer
• swelling and narrowing of blood vessels in the brain, which may lead to stroke if left untreated

Zeposia may cause harm to a developing fetus, and women of childbearing potential should use effective contraception while taking Zeposia and for at least three months after stopping the medication. Women who are pregnant or planning to become pregnant should inform their healthcare provider before initiating the treatment.

Some people may experience a severe return of disease activity upon discontinuing treatment, so patients should be closely monitored when Zeposia is stopped and begin appropriate treatment as needed.

Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.