How Do Sphingosine 1-phosphate Receptor Modulators Work?

Sphingosine 1-phosphate (S1P) receptor modulators are a class of drugs used to treat and prevent the worsening of disability in adults with relapsing-remitting forms (course of disease where symptoms flare up from time to time) of multiple sclerosis. 

Multiple sclerosis is a chronic, devastating inflammatory disease of the brain, spinal cord, and optic nerves that often progresses and causes severe neurological, physical, and cognitive effects. Signs and symptoms of multiple sclerosis include:

• Muscle weakness/spasms
• Numbness/tingling sensation
• Extreme tiredness
• Loss of muscle coordination
• Blurred vision
• Impaired speech
• Poor bladder/bowel control
• Trouble walking

S1P receptor modulators are immunomodulatory medications that prevent the immune cells (lymphocytes) from attacking the nerves in the brain and the spinal cord. They selectively bind to various S1P receptors (1, 3, 4, and 5) found on lymphocytes and suppresses the migration of lymphocytes from lymph nodes to the location of the inflammation, leading to a lower level of lymphocytes circulating in the peripheral circulation and thus preventing the damage caused to the nerves.

The inhibitors of S1P receptor modulators are administered via the oral route, typically once a day with or without food.

S1P receptor modulators are indicated for:

• Relapsing forms of multiple sclerosis, include clinically isolated syndrome (nerve symptom episodes that last at least 24 hours), relapsing-remitting disease, and active secondary progressive disease (course of disease where relapses occur more often)
• Ulcerative colitis (a condition that causes swelling and sores in the lining of the colon [large intestine] and rectum) 

Some of the common side effects include:

• Nausea
• Vomiting
• Diarrhea
• Headache
• Weakness
• Pain in the arms, legs, hands, or feet
• Abdominal pain
• Decreased appetite
• Back pain
• Upper respiratory tract infection 

Other rare side effects include:

• Dizziness 
• Fatigue 
• Rash/hives/itching
• Hypertension (high blood pressure)
• Increased liver enzymes
• Hair loss
• Peripheral edema (swelling of lower legs or hands)
• Bradycardia (slower heart rate)
• Dyspnea (shortness of breath)
• Sinusitis 
• Blurred vision 
• Seizures 

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Generic and brand names of S1P receptor modulators include:

• Siponimod
• Mayzent
• Fingolimod
• Gilenya
• Ozanimod
• Zeposia