S5015 Successful Use of Ozanimod in a Patient With Overlapping Multiple Sclerosis and Crohn’s Disease

Introduction: Multiple sclerosis (MS) and Crohn’s disease (CD) are autoimmune disorders with abnormal immune responses. Although uncommon, the coexistence of MS and CD presents unique treatment challenges due to the need for immune modulation across different organ systems. Ozanimod (Zeposia®), a sphingosine 1 phosphate receptor modulator, is approved for relapsing MS and moderate to severe active ulcerative colitis (UC) and is being studied for use in CD. We present a case of overlapping MS and CD successfully treated with ozanimod. Case Description/Methods: A 35-year-old woman with a history of CD s/p ileocecectomy in 2014, MS, iron deficiency anemia, and a family history of UC and MS was referred for CD management. Diagnosed with CD in 2013, she was initially treated with steroids, then underwent surgery for obstruction and was maintained on Humira. In 2021, she developed neurological symptoms including left optic neuritis and was diagnosed with MS. Humira was discontinued, and she was switched to tysabri, which stabilized her MS. After relocating in 2024, she was clinically stable on evaluation, though she showed mild anemia. A month later, she presented with a 2-week history of cramping and loose stools. Computed tomography revealed active ileitis. She was started on prednisone and ozanimod. Follow-up computed tomography enterography after 2 months showed near-complete resolution of inflammation. She has remained stable on ozanimod for 9 months without MS or CD flares. Discussion: MS and CD overlap is uncommon, with a pooled risk ratio of 1.54 and a prevalence of ∼0.08%. Natalizumab is approved for MS and effective in CD but limited by the risk of PML. Ozanimod, approved for MS and UC, is being evaluated for CD in phase III YELLOWSTONE trials. Phase II STEPSTONE data showed clinical, endoscopic, and histological benefits. In this case, ozanimod induced and maintained remission in both MS and CD, highlighting its potential as a dual-purpose therapy.