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Link to original content: http://pubmed.ncbi.nlm.nih.gov/39139217/
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Review
. 2024 May 15;7(4):282-289.
doi: 10.1093/jcag/gwae013. eCollection 2024 Aug.

Practical guidance for managing patients with moderate-to-severe ulcerative colitis using small molecule therapies

Vipul Jairath  1 , Waqqas Afif  2 , Brian Bressler  3 , Janet E Pope  4 , Daniel Selchen  5 , Laura E Targownik  6   7 , Remo Panaccione  8
Affiliations
Review

Practical guidance for managing patients with moderate-to-severe ulcerative colitis using small molecule therapies

Vipul Jairath et al. J Can Assoc Gastroenterol. .

Abstract

Ulcerative colitis (UC) is a severe and debilitating illness that affects the quality of life and physical health of many Canadians. Given the dynamic and progressive nature of the disease, advanced therapies are required to support its long-term management. The emergence of small molecule therapies offers novel treatment options that target mechanisms central to the immunopathology of UC. Sphingosine-1-phosphate (S1P) receptor modulators and Janus-activated kinase inhibitors are 2 classes of therapies that target unique pathways to attenuate inflammation and modulate the immune response characteristic of UC. This review aims to provide practical guidance on how these therapeutic options can best be used to optimize treatment management and highlight the emerging role of small molecule therapies as a treatment strategy for UC.

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Conflict of interest statement

V.J. has served as an Advisory Board Member/ Consultant for AbbVie, Alimentiv Inc. (formerly Robarts Clinical Trials Inc.), Arena Pharmaceuticals, Asahi Kasei Pharma, Asieris, Astra Zeneca, Avoro Capital, Celgene/BMS, Celltrion, Eli Lilly, Endpoint Health, Enthera, Ferring, Flagship Pioneering, Fresenius Kabi, Galapagos, Genentech, Gilde Healthcare, Gilead, GlaxoSmithKline, Innomar, JAMP, Janssen, Merck, Metacrine, Mylan, Pandion, Pendopharm, Pfizer, Protagonist, Prometheus Biosciences, Reistone Biopharma, Roche, Roivant, Sandoz, Second Genome, Sorriso, Synedgen, Takeda, TD Securities, Teva, Topivert, Ventyx, and Vividion Therapeutics. He has served as a speaker for Abbvie, Ferring, BMS, Galapagos, Janssen, Pfizer, Fresenius Kabi, and Takeda. V.J. has received research support from Celgene/BMS, Pfizer, Abbvie, Boehringer Ingelheim, Eli Lilly, Janssen, Takeda, Gilead Sciences, and Tigenix. W.A. has served as a speaker, an advisory board member, and/or a clinical investigator for Abbvie, Amgen, Bausch, BMS, Celltrion, Innomar, Janssen, Merck, Pfizer, Sanofi, and Takeda. B.B has served as an advisor/speaker for Ferring, Janssen, Abbvie, Takeda, Pfizer, BMS, Merck, Sandoz, Organon, Lifelabs, Celltrion; and as an advisor for Alimentiv, Gilead, Iterative Health, Merck, Amgen, Pendopharm, Eli Lilly, Fresenius Kabi, Mylan, Viatris, Bausch Health, Jamp Pharma, and Eupraxia. B.B. has received research support from Janssen, Abbvie, GSK, BMS, Amgen, Genentech, Merck, BI, Qu Biologic; and has stock options with Qu Biologic. J.E.P. has served as an advisor/speaker for AbbVie, Astra Zeneca, BI, BMS, Frensenius Kabi, GSK, Janssen, JMP, Lilly, Mallinckrodt Pharmaceuticals, Mitsubishi Tanabe Pharma, Novartis, Organon, Pfizer, Sandoz, Samsung, Viatris. D.S. has served as an advisor/speaker for Apotex, Bayer, Biogen, BMS, Merck, EMD Serono, Novartis, Pharma Science, Roche, Sanofi, Teva. L.T. has received grants and/or contracts from AbbVie Canada, Pfizer Canada, Takeda Canada, Fresnenius Kabi Canada, and Amgen Canada; consulting fees from Janssen Canada, AbbVie Canada, Pfizer Canada, Takeda Canada, Roche Canada, Gilead Canada, Sandoz Canada, Amgen Canada, Fresnius Kabi, and Viatris; and honoraria for advisory board participation and/or development from Janssen Canada, AbbVie Canada, Pfizer Canada, Takeda Canada, Roche Canada, Gilead Canada, Sandoz Canada, Amgen Canada, and Organon Canada. R.P. has received consulting fees from AbbVie, Abbott, Alimentiv (formerly Robarts), Amgen, Arena Pharmaceuticals, AstraZeneca, Biogen, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Celltrion, Cosmos Pharmaceuticals, Eisai, Elan, Eli Lilly, Ferring, Fresenius Kabi, Galapagos, Genentech, Gilead Sciences, Glaxo-Smith Kline, JAMP Bio, Janssen, Merck, Mylan, Novartis, Oppilan Pharma, Organon, Pandion Pharma, Pendopharm, Pfizer, Progenity, Protagonist Therapeutics, Prometheus Biocsciences, Roche, Satisfai Health, Sandoz, Shire, Sublimity Therapeutics, Theravance Biopharma, UCB, Takeda Pharmaceuticals, Trellus, Viatris, and Ventyx; speaker fees from Abbvie, Amgen, Arena Pharmaceuticals, BMS, Celgene, Eli Lilly, Ferring, Fresenius Kabi, Gilead Sciences, Janssen, Merck, Organon, Pfizer, Roche, Sandoz, Shire, and Takeda Pharmaceuticals; has served on advisory boards for Abbvie, Amgen, Arena Pharmaceuticals, Bristol-Myers Squibb, Celgene, Celltrion, Eli Lilly, Ferring, Galapagos, Genentech, Gilead Sciences, Glaxo-Smith Kline, Janssen, Merck, Mylan, Oppilan Pharma, Pandion Pharma, Pfizer, Sandoz, Shire, Sublimity Therapeutics, Theravance Biopharma, and Takeda Pharmaceuticals; and has received research/educational support: Abbvie, Ferring, Janssen, Pfizer, and Takeda.

Figures

Figure 1.
Figure 1.
Advanced small molecule therapies that target novel mechanisms of action are emerging as an effective treatment for moderate-to-severe ulcerative colitis.
Figure 2.
Figure 2.
Side effects of S1P receptor modulators in moderate-to-severe ulcerative colitis. Side effects of S1P receptor modulators include, but are not limited to, hypertension, macular oedema, bradycardia or arrythmia, lymphopenia, reduced liver function, and development of shingles or varicella.
Figure 3.
Figure 3.
Side effects of JAK inhibitors in moderate-to-severe ulcerative colitis. JAK inhibitors may cause side effects including, but not limited to, venous thromboembolism, increased cholesterol levels, elevated risk of non-melanoma skin cancer, lymphopenia, reduced liver function, and increased risk of shingles or varicella.
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