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Guideline review: Tofacitinib for adults with moderately to severely active ulcerative colitis - NICE guidance

Akudo Nwaogu1, Ashley Bond2, Philip J Smith2

  • 1Department of Medicine, Royal London Hospital, Barts Health NHS Trust, London, London, UK.

Frontline Gastroenterology
|February 22, 2021
PubMed

Insights

Tofacitinib effectively treats ulcerative colitis (UC) by inhibiting Janus kinases (JAKs). This review covers its efficacy, guidelines, and safety considerations like lipid increases and thromboembolism risk.

Area of Science:

  • Immunology
  • Gastroenterology
  • Pharmacology

Background:

  • Tofacitinib is an oral Janus kinase (JAK) inhibitor targeting JAK1 and JAK3.
  • It has demonstrated efficacy in rheumatoid arthritis and kidney transplant rejection prevention.
  • Ulcerative colitis (UC) is a chronic inflammatory bowel disease requiring effective treatment options.

Purpose of the Study:

  • To review the efficacy of tofacitinib in treating moderate to severe ulcerative colitis (UC).
  • To discuss current therapeutic guidelines and safety considerations for tofacitinib in UC management.
  • To provide commentary on post hoc analyses regarding lipid increases and thromboembolism risk.

Main Methods:

  • Review of two separate phase III placebo-controlled trials assessing tofacitinib's 8-week induction and 52-week maintenance efficacy in UC.
  • Analysis of National Institute for Health and Care Excellence (NICE) recommendations.
  • Examination of post hoc analyses concerning safety outcomes.

Main Results:

  • Tofacitinib demonstrated superiority over placebo in both induction and maintenance phases for UC treatment.
  • NICE recommends tofacitinib for adult patients with moderate to severe UC unresponsive to conventional or biologic therapies.
  • Post hoc analyses identified lipid increases and thromboembolism risks, leading to updated therapeutic guidance.

Conclusions:

  • Tofacitinib is an effective oral treatment for moderate to severe UC, particularly when other therapies fail.
  • Updated guidance reflects safety considerations, including lipid metabolism and thromboembolic events.
  • Continued monitoring and adherence to revised therapeutic recommendations are crucial for optimal patient outcomes.
Keywords:
inflammatory bowel diseaseulcerative colitis

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