Tofacitinib for Biologic-Experienced Hospitalized Patients With Acute Severe Ulcerative Colitis: A Retrospective...

Area of Science:

• Gastroenterology
• Immunology
• Pharmacology

Background:

• Over 30% of acute severe ulcerative colitis (ASUC) patients require colectomy despite rescue therapies.
• Tofacitinib, a Janus kinase inhibitor, shows efficacy in ulcerative colitis treatment.
• Investigating tofacitinib's role in preventing colectomy for ASUC is crucial.

Purpose of the Study:

• To evaluate the efficacy of tofacitinib induction therapy in preventing colectomy in biologic-experienced ASUC patients.
• To assess the 90-day colectomy risk associated with tofacitinib use in hospitalized ASUC patients.

Main Methods:

• Retrospective case-control study of biologic-experienced ASUC patients requiring intravenous corticosteroids.
• Tofacitinib recipients were matched 1:3 to controls based on gender and admission date.
• Cox regression analysis adjusted for disease severity to estimate 90-day colectomy risk.

Main Results:

• Tofacitinib was associated with a significantly reduced 90-day colectomy risk (HR: 0.28, P=.018).
• A tofacitinib dose of 10 mg three times daily showed significant protection against colectomy (HR: 0.11, P=.008).
• Complication and steroid dependence rates were similar between tofacitinib and control groups.

Conclusions:

• Tofacitinib, combined with intravenous corticosteroids, appears effective for ASUC induction in biologic-experienced patients.
• Higher doses of tofacitinib demonstrated a protective effect against colectomy.
• Further prospective trials are necessary to determine optimal tofacitinib dosing and safety for ASUC.