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Inflammatory bowel disease (IBD), namely Ulcerative Colitis (UC) and Crohn's Disease (CD), is believed to be due to a dysregulation of the innate immune response. The complexity of the immune cascade offers both a challenge and an opportunity to researchers seeking out new treatments for IBD, as various points along the inflammatory pathways can be targeted for interruption. Sphinogosine-1-phosphate (S1P) is a phospholipid molecule with wide ranging biological effects caused by binding five known S1P receptor subtypes. Ozanimod is a small molecule drug that selectively targets S1P receptors 1 and 5 which play a crucial role in lymphocyte trafficking. In clinical trials for both UC and CD, it has been shown to induce a reversible lymphopenia which correlates with response to therapy. Reported adverse events include infection, anemia, and elevated liver enzymes. Rare instances of bradycardia, heart block, and macular edema were also reported. As a newly available therapy approved for UC patients, we aim to summarize ozanimod's novel mechanism of action, pre-clinical and clinical trial results, and to give context to this newly available drug that gastroenterologists may utilize in their treatment algorithm.

Background To date, studies investigating the inflammatory bowel disease (IBD) patient experience with coronavirus disease 2019 (COVID-19) have consistently reported that the observed rate of COVID-19 within this population is similar to the general population. Limited research has suggested that corticosteroid use in the IBD population may be associated with worse COVID-19 outcomes, but it is still yet to be determined if specific IBD-related clinical factors are associated with worse outcomes. Our goal was to describe clinical COVID-19 outcomes for IBD patients and to identify the clinical factors that may be associated with worse outcomes. Methods In this retrospective study, we utilized the inpatient database within the largest hospital network in the New York City Metropolitan area to identify all IBD patients with confirmed COVID-19. Results Of 83 IBD/COVID-19 patients presenting to a hospital network emergency room, 56 were hospitalized. Overall, 19.6% of hospitalized IBD patients died, compared with 22.2% of all hospital system COVID-19 patients during the time period. There was no association between pre-admission corticosteroid use or biologic treatment with a severe course of COVID-19. Conclusions In contrast to some prior reports, we did not observe an association of pre-admission corticosteroid use and adverse outcomes. While the mortality rate was high for IBD/COVID-19 patients, it was not greater than that for hospitalized COVID-19 patients generally. Though our results are encouraging, we continue to support the recommendations of the leading gastrointestinal and IBD societies to regard our patients as “at risk”, and to observe caution in their care.

Ulcerative colitis (UC) has been identified as a distinct disease entity since the 1800s. Increasing rates, which paralleled industrialization in the west, are now being observed worldwide. While the disease presentation has changed little over time, our ability to diagnose UC has progressed from simple rigid instruments to advanced high-definition video colonoscopes. Advances in diagnostics have been matched by increasing options for medical therapy. The advent of effective therapies, beginning with systemic corticosteroids and sulfasalazine/mesalamine derivatives, lead to an era of nonspecific immunosuppressive therapy and to increasingly targeted biologic and small molecule treatments in the present day. The goal of this review is to provide a comprehensive guide to current evidence-based diagnosis and medical management of UC, from its mildest to most severe presentations, highlighting areas of agreement/standard of care in each section. Additional focused discussion is provided on advances in inflammatory bowel disease (IBD)-colon cancer screening/surveillance, as well as a review of the new “treat to target” paradigm, which is designed to move beyond symptomatic management to deep tissue healing and improved long-term outcomes.