Postoperative Outcomes in Tofacitinib-Treated Patients With Acute Severe Ulcerative Colitis Undergoing Colectomy

Area of Science:

• Gastroenterology
• Immunology
• Surgical Outcomes

Background:

• Up to 30% of acute severe ulcerative colitis (ASUC) patients require colectomy despite medical therapy.
• Janus kinase (JAK) inhibitors like tofacitinib are emerging treatments for ASUC.
• Data comparing postoperative complications after tofacitinib versus infliximab for ASUC are limited.

Purpose of the Study:

• To evaluate the risk of postoperative complications in ASUC patients who received tofacitinib before colectomy compared to those treated with infliximab.
• To assess differences in overall and serious postoperative complications between tofacitinib and infliximab treatment groups.

Main Methods:

• A multicenter, retrospective, case-control study was conducted.
• Patients with ASUC who underwent colectomy were compared based on prior treatment with tofacitinib or infliximab.
• Multivariable regression analysis adjusted for open surgery and corticosteroid exposure was used to compare outcomes, primarily serious postoperative complications within 30 days.

Main Results:

• The study included 41 tofacitinib-treated patients and 68 infliximab-treated patients.
• Tofacitinib-treated patients had significantly lower overall postoperative complication rates (31.7% vs 64.7%).
• No significant difference in serious postoperative complications was found (12% vs 27.9%), though multivariable analysis showed a trend towards lower risk with tofacitinib (OR 0.28; P = .061).

Conclusions:

• Tofacitinib treatment for ASUC prior to colectomy was associated with a significantly lower rate of overall postoperative complications compared to infliximab.
• No significant difference in the risk of serious postoperative complications was observed between the two treatment groups.
• Larger prospective trials are necessary to validate these findings.