Background To quantify the effects of COVID‐19 on our inflammatory bowel disease (IBD) unit, including service provision, prescribing practices and use of therapeutic drug monitoring (TDM). Methods We performed a single centre retrospective observational cohort study. Data was extracted from our IBD database, electronic patient records and radiology/endoscopy reporting systems between 16/3/20‐17/4/20 and the corresponding period in 2019. Results A similar number of patients commenced biologic therapy before COVID‐19 (n=37) and during the pandemic (n=36). Patients in the pre‐COVID‐19 cohort were older (median 36 vs. 29 years, p=0.009) with a longer median disease duration (9.3 vs. 5.2 years, p=0.02). During COVID‐19 there was a non‐significant increase in prescribing of vedolizumab (8/37, 22% vs. 14/36, 39%, p=0.13) and a higher proportion of patients were anti‐TNF‐naïve (3/17, 18% vs. 18/24, 74%, p=0.0004). There was a reduction in use of concomitant immunomodulators (22/29, 76% vs. 4/34, 12%, p<0.0001) and increased biologic use in thiopurine‐naïve patients (3/37, 8% vs. 15/36, 42%, p=0.001). Use of TDM fell by 75% (240 vs. 59 tests). Outpatient appointments fell by 68% and were conducted via telemedicine. MRI scanning, endoscopy, luminal surgery and inpatient numbers fell by 87%, 85%, 100% and 82% respectively. IBD Clinical Nurse Specialist and Pharmacist helpline contacts increased by 76% and 228% respectively. Conclusions We observed prescribing differences during COVID‐19, bypassing the initiation of immunomodulators and/or anti‐TNF therapy in favour of vedolizumab with a reduction in immunomodulator prescribing. We also observed a rapid reorganisation of service provision, including a shift towards telemedicine and online solutions.

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.

Biosimilars have delivered significant cost savings, increasing access to biologics for many patients. While numerous studies have demonstrated no difference in efficacy between originators and biosimilars, the impact of switching between originator and biosimilar adalimumab on drug levels and disease activity in real world cohorts remains largely unknown. We conducted a retrospective observational cohort study of, 392 patients with IBD (347 (89%) CD, 45 (11%) UC) who had switched from Humira to the biosimilar, Idacio, between February - November, 2021. Therapeutic drug monitoring was carried out using a commercially available, drug sensitive ELISA (LISA TRACKER, Theradiag). Therefore, antidrug antibodies could only be detected in the setting of low or absent serum drug concentrations. Drug level data was parametric and analysed by paired student t test and Pearson correlation coefficient. CRP data was analysed by Wilcoxon test. Data was analysed using GraphPad Prism. The baseline characteristics of the study participants are presented in the table., 96 patients had paired adalimumab drug levels before and after the switch. There was no difference between median adalimumab drug levels before and after the switch (9.5 vs, 9.2 ug/mL, p=0.67). Furthermore, drug levels were positively correlated before and after switching demonstrating similar levels at both time points for most patients (correlation co-efficient, 0.47, p <, 0.0001) (Figure, 1). Prior to switching, no patients had detectable antidrug antibodies. Following switch, one patient (1%) developed high-titre antidrug antibodies and undetectable drug levels. Prior to switch their levels were, 14, without detectable antidrug antibodies CRP levels were available for, 163 patients before and after the switch, with no difference in median CRP at either time point (1 vs, 1mg/L p=0.60). 33 (8%) patients experienced injection site pain with Idacio and therefore, switched back to Humira. The annual cost saving to the UK National Health Service for patients on weekly and every other week switched to Idacio is £5096 and £2548, respectively Our study demonstrates stable pharmacokinetics and biochemical disease activity amongst a significant cohort of patients switching from originator to biosimilar adalimumab as part of a real-world switching program. However, a small proportion of patients did not tolerate Idacio due to injection site pain. There are clear financial benefits in carrying out non-medical, biosimilar switching programs but further work is needed to evaluate the effect on clinical and endoscopic disease activity in a real-world setting.