Sphingosine 1 phosphate receptor (S1PR) modulators are the latest drug class to have received approval for the treatment of ulcerative colitis, and have brought a new mechanism of action to this landscape. They target immune cell trafficking, specifically the egress of lymphocytes from lymph nodes to the bloodstream, and have proven to be an efficacious and safe anti-inflammatory mechanism. This narrative review aims to distil the key trial data on the efficacy and safety of ozanimod and etrasimod, the two S1PR modulators currently licensed for use in UC. We discuss the higher response rates in the advanced therapy naive versus exposed subgroups. We summarise their safety profiles, taking into consideration open label extension data. Finally, we consider where this class of drugs may be best placed in the treatment landscape and also provide a practical guide for their use in clinical practice.

Objectives: Data on the use of adalimumab (ADA) biosimilar Idacio (Fresenius Kabi) in inflammatory bowel disease is relatively sparse, whereas the efficacy and safety of other biosimilars have been well described. We evaluated the pharmacokinetics and clinical outcomes in a real‐world cohort of patients who switched from originator to Idacio. In addition, we surveyed patients’ experiences of the switching process. Methods: A retrospective analysis of all IBD patients who participated in a nonmedical switch from ADA originator to Idacio at a tertiary centre was performed. Data on ADA drug levels, antibody levels and clinical and laboratory indices of disease activity (Harvey Bradshaw Index for Crohn’s disease, Simple Clinical Colitis Activity Index for ulcerative colitis, C‐reactive protein and faecal calprotectin) were collected prior to and after switching to Idacio. An anonymised patient survey was undertaken to evaluate injection site pain, level of understanding and acceptability of the switch. Results: Four hundred and three patients were included. No difference in the ADA levels before and after switching was found ( p = 0.78). There were also no differences in clinical ( p = 0.06), biochemical ( p = 0.36) and biomarker ( p = 0.84) remission rates after switching. In the survey, patients reported moderate injection site pain after switching. The majority of patients self‐reported good levels of understanding of the financial rationale for switching, which correlated with a higher degree of acceptability of the switch ( p < 0.05). Conclusions: Switching from ADA originator to Idacio appears effective and well tolerated. Patient engagement and education should be a key part of all nonmedical biosimilar switches.