VIDEO: New, emerging therapies for ulcerative colitis

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We’ve seen new therapies in recent years that are very exciting, mainly IL-23 inhibitors, JAK inhibitors and S1PR modulators. These are the new players, and I actually find them very interesting for different reasons.

Let’s start with the IL-23 inhibitors. For ulcerative colitis, mirikizumab has been recently approved, but we’re also expecting other IL-23 inhibitors to come into play in the next few months, guselkumab and risankizumab. These therapies are very effective, and at the same time, they have a very nice safety profile. I'll find them the middle of the road between the efficacy of anti-TNF but with less potential risk of infection and side effects. I like these therapies in the patient with moderate to severe ulcerative colitis.

JAK inhibitors, tofacitinib and more recently, upadacitinib have also really changed how we treat more severe ulcerative colitis, specifically severe UC that did not respond to anti-TNF or lost response to anti-TNF. We’ve been using them in our practice to treat patients with a more severe ulcerative colitis. They’re also very effective in treating several of the extraintestinal manifestation of UC. They have a role to play in patients with UC and ankylosing spondylitis. And finally, we are seeing more and more data looking at using JAK inhibitors in the context of acute severe ulcerative colitis. Typically, we use anti-TNF infliximab to treat patients with acute severe UC in the hospital, but JAK inhibitors now, potentially, will be playing a more significant role in treating these patients.

And finally, S1PR modulators. These are a very effective oral therapy for moderate UC, mainly in the bionaive population. In my opinion, they actually play a very important role in filling this unmet need of having a safe, effective oral therapy in patients with UC who do not respond to mesalamine but are not ready for a biologic yet. We have two drugs in this class, ozanimod and etrasimod. And then in the pipeline, there’s now increased interest in the new mechanism of action of therapies, mainly antibodies to tumor necrosis factor like cytokine A1 or anti-TL1A. In a phase 2 trial, anti-TL1As have been shown to be effective in inducing remission at week 12 in patients with moderate to severe UC. I'm looking forward to seeing more of anti-TL1A in term of potential therapies for ulcerative colitis and inflammatory bowel disease in general.