Plain Language Summary: Sphingosine-1-phosphate receptor modulators in ulcerative colitis – a narrative review of current evidence and practical considerations

What is ulcerative colitis and how is it treated?

Ulcerative colitis is a chronic, relapsing and remitting condition that predominantly affects the large bowel. Some people with moderate or severely active ulcerative colitis require advanced therapy in the form of biological or small-molecule drugs (called advanced therapies) to maintain control of their symptoms.

What advanced therapies are available?

Sphingosine-1-phosphate receptor modulators (S1PRMs) are a newer class of small-molecule medications for ulcerative colitis. They act by blocking specific signals in the immune system, which prevent the movement of white blood cells from the lymph nodes into the intestine.

What S1PRMs have been approved?

Two drugs that have been approved in this class for the treatment of ulcerative colitis: ozanimod and etrasimod. Both are oral medications that are taken once a day.

Summary of this review

Large clinical trials have shown that both ozanimod and etrasimod are effective in treating moderate to severe ulcerative colitis and have a good safety profile. However, they are contraindicated in people with certain co-existing conditions, such as electrical conduction abnormalities in the heart, severe heart failure, stroke and diseases of the macula (a part of the retina in the eye, the light-sensitive lining responsible for sharp detailed vision and colour perception). They are also contraindicated in pregnancy. Ozanimod and etrasimod have similar screening and monitoring requirements such as baseline electrocardiogram and blood tests.

There are no studies directly comparing ozanimod and etrasimod with each other, or with currently licensed treatments for ulcerative colitis. Future studies and research may help answer such questions. Nevertheless, S1PRMs may be a suitable and convenient option for people living with ulcerative colitis, who prefer not to undergo injections or hospital infusions. These medications may also be beneficial for patients who have not responded to other advanced treatments.

Article available at: https://doi.org/10.7573/dic.2025-7-3