Raymond Cross, MD, on S1Ps for Treatment of IBD

S1Ps may work best for patients with moderate to more moderate-severe range of ulcerative colitis in the outpatient setting, particularly those earlier in their treatment journey, Dr Raymond Cross said during his presentation at the AIBD regional meeting.

Raymond Cross, MD, is professor of medicine and director of the IBD Program at the University of Maryland School of Medicine in Baltimore.

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TRANSCRIPT:

Hello, everyone. I'm Raymond Cross, professor of medicine at the University of Maryland School of Medicine. I just gave a talk entitled Harnessing the Utility of Selective Sphingosine 1-Phosphate Receptor Modulators to Optimize Patient Care in IBD. Over the next few minutes, I'm going to go over the highlights of that presentation.

S1P receptor modulators are a new mechanism of action for treatment of ulcerative colitis. In MS, our neurologists have had this mechanism for quite some time, but it's definitely a new kid on the block for treatment of ulcerative colitis. So one of the things that I introduced early on in the talk was the mechanism of action and how this works.

Briefly, the way I explained this to patients is that our white cells are boats. They need to go to areas of inflammation and dock there. Of course, there has to be a boating analogy in the Chesapeake. And what these S1P modulators do is they don't allow the boats or the white cells to leave the lymph node and get to the affected organ, in this case, the colon. We also reviewed the pivotal clinical trials, which led to approval by our regulatory agencies for use in patients with ulcerative colitis. When this drug was first launched in the ulcerative colitis space, there were a lot of concerns about safety. There were concerns related to the types of things that we could eat and drink because of potential drug interactions like wine, beer, or cheese. There were concerns about potential ocular side effects, such as macular edema. There were concerns about cardiac conduction abnormalities. There was concerns about serotonergic syndrome in patients on concurrent antidepressants.

So we definitely did a deep dive into the safety of these drugs, which is incredibly reassuring. The most common effect that we see here is about a 1% risk per year of serious infection and very, very low rates of macular edema or cardiac conduction abnormalities, and very reassuring data on use with concurrent antidepressant therapies. And then we spent a lot of time just talking about the pragmatics of using these drugs in clinical practice. So you need to get a baseline opto exam for patients with a history of inflammatory eye disorders and diabetes. You need to get a baseline EKG.

And lastly, I talk about positioning of these therapies, which for me, your less sick, so your patient with more moderate on the moderate-severe range of ulcerative colitis in the outpatient setting, particularly one that's earlier in their treatment journey, so bio-naive or perhaps has seen only one advanced therapy, would be an ideal person to receive these drugs. Thank you very much.

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