The tumor necrosis factor (TNF)-α antagonists infliximab1,2 and adalimumab3,4 (and their equivalentbiosimilars) are used in both ulcerative colitis (UC) and Crohn’s disease (CD), asare the anti-α4β7-integrin vedolizumab5,6 and the anti-interleukin(IL)12/23 ustekinumab.7 The anti-TNF golimumab,8 the JAK inhibitors tofacitinib9 and upadacitinib,10 and the sphingosine 1-phosphate receptor modulator ozanimod11 are used in UC only, while the anti-TNF certolizumab pegol,12 the anti-integrin natalizumab,13 and the anti-IL23 risankizumab14,15 are used in CD only. Here, S1PR1 is linked to Cowden disease.