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Tofacitinib use in ulcerative colitis: An expert consensus for day-to-day clinical practice
Rupa Banerjee1, Vishal Sharma2, Rajendra Patel3
1Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Mindspace Road, Gachibowli, Hyderabad, 500 032, India. dr_rupa_banerjee@hotmail.com.
Tofacitinib offers a valuable treatment option for ulcerative colitis, aiding in remission induction and maintenance, especially after other therapies fail. Careful patient selection and monitoring are crucial due to potential risks like infections and thrombosis.
Area of Science:
- Gastroenterology
- Immunology
- Pharmacology
Background:
- Increasing global incidence of inflammatory bowel disease (IBD).
- Need for clinical guidance on advanced therapies in ulcerative colitis (UC).
- Tofacitinib as a Janus kinase (JAK) inhibitor for UC treatment.
Purpose of the Study:
- To provide expert consensus on tofacitinib usage in ulcerative colitis.
- To guide clinicians on appropriate dosing, patient selection, and risk management.
- To outline the role of tofacitinib in induction and maintenance of UC remission.
Main Methods:
- Generation of an expert consensus document.
- Review of clinical evidence for tofacitinib in ulcerative colitis.
- Formulation of recommendations for clinical practice.
Main Results:
- Tofacitinib is effective for induction and maintenance of remission in UC.
- Recommended induction dose: 10 mg twice daily (BD); maintenance: 5 mg BD after response.
- Contraindications/cautions include elderly, cardiovascular risks, thrombosis history, malignancy risk, and specific infections.
Conclusions:
- Tofacitinib is a viable option for biologic-refractory, steroid-dependent, or thiopurine-refractory UC.
- Pre-treatment screening for infections (Hepatitis B, TB) and vaccinations (Herpes zoster) are essential.
- Use requires caution in specific patient populations due to increased infection and thrombosis risks.
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