Raymond Cross, MD, on Leukocyte Trafficking

Dr Cross reviews his presentation on leukocyte trafficking in treatment for inflammatory bowel disease from the Advances in Inflammatory Bowel Disease Regional Meeting on April 2, 2022.

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

TRANSCRIPT

Ray Cross, MD
Hello everyone. I'm Raymond Cross from the University of Maryland School of Medicine. In case you missed the Regional Advances in IBD April 2nd in Raleigh, I want to give you a recap of my talk on leukocyte trafficking.

We're fortunate now that we have multiple therapies outside of an anti-TNF to treat our patients. Many of you are familiar with vedolizumab, which is an anti-integrin leukocyte trafficking agent and, of course, natalizumab which we used fair frequently in the past. Now the use of that has been really gone by the wayside as vedolizumab has a safer mechanism of action.

For vedolizumab, we did a review of the pivotal studies that led to approval by the FDA in both ulcerative colitis and Crohn's disease. We also reviewed real world data, comparing vedolizumab to anti-TNF therapy as well to other novel biologics like ustekinumab. We also discussed a subcutaneous formulation which is being actively studied and will likely be approved in the United States within the next year. That's really going to be a game changer, as patients are going to be able to self-administer vedolizumab every two weeks. So that will be really an exciting option for our patients.

Now we have a new kid on the block, ozanimod, which is an S1P modulator, so new mechanism action for many of us, but it also impacts leukocyte trafficking. So I have a nice analogy I tell my patients. If you think about anti-integrin receptors lining the intestines and your white cells are boats, so the anti-integrins are the docks, and vedolizumab doesn't let the boats dock in the intestine. If you think about S1P modulators, they trap the lymphocytes in the lymph nodes so that they can't get out. So think about the boating analogy again, the boats never leave the dock in the first place, so affects leukocyte trafficking, but an alternate mechanism.

What's really cool about ozanimod is it's an oral medication and actually works fairly rapidly. So in my talk, we reviewed the pivotal trials leading to approval, including some of the novel endpoints that were looked at in this trial, such as histologic remission and combined histologic and endoscopic healing. We also looked at some abstracts that have not yet been published in full, looking at disease state, cross disease state, safety in both MS and ulcerative colitis, looking at various safety outcomes, which are quite reassuring.

Thank you very much for your attention. I hope that you'll have a chance to listen to one of these leukocyte trafficking talks at one of the future Regional Advances in IBD or even at the National Advances in IBD Conference.