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Rescue therapy with upadacitinib in medically refractory pediatric ulcerative colitis

Maria Miller1,2, Ashish S Patel1,2, Brad Pasternak1,2

  • 1Division of Pediatric Gastroenterology Phoenix Children's Hospital Phoenix Arizona USA.

JPGN Reports
|May 17, 2024
PubMed

Insights

Janus kinase (JAK) inhibitors may offer a new treatment for pediatric inflammatory bowel disease (IBD). A 13-year-old with refractory ulcerative colitis (UC) achieved remission with a JAK inhibitor, avoiding colectomy.

Area of Science:

  • Gastroenterology
  • Immunology
  • Pediatric Medicine

Background:

  • Pediatric inflammatory bowel disease (IBD) treatment options are limited.
  • Janus kinase (JAK) inhibitors are approved for adult IBD but their efficacy in pediatric populations is not well-established.

Observation:

  • A 13-year-old female patient presented with severe ulcerative colitis (UC) refractory to multiple therapies including 5-aminosalicylate, azathioprine, adalimumab, vedolizumab, and ustekinumab.
  • Despite extensive treatment, the patient experienced persistent pancolitis and required hospitalization, with the family declining colectomy.

Findings:

  • The patient was initiated on upadacitinib, a JAK inhibitor.
  • Within one week of starting upadacitinib, her symptoms resolved, leading to a steroid-free remission.

Implications:

  • This case suggests that JAK inhibitors may be a viable advanced therapy option for pediatric patients with extensively refractory UC.
  • Early consideration of JAK inhibitors could potentially prevent the need for colectomy in select pediatric IBD cases.

Keywords:
Janus kinase inhibitorinflammatory bowel diseasepediatrics

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