Exploring the role of tofacitinib in managing chronic pouchitis: A systematic review and meta-analysis

Tofacitinib, commonly used for ulcerative colitis, has shown promising results in the management of chronic pouchitis (CP). We performed a pooled analysis of the efficacy and safety of tofacitinib for CP.

We searched multiple databases for articles reporting the outcomes of tofacitinib for the treatment of CP and conducted a meta-analysis.

8 studies including 99 subjects (mean age: 37.5 years and 55.6 % males) were analyzed. The pooled clinical and endoscopic response rate was 47.7 % [Cl 33.3-62.6 %; I2= 40 %] and 51.7 % [Cl 37.4-65.7 %; I2=34 %], respectively. The remission rate was 41.2 % [Cl 26.6-57.6 %; I2= 0 %]. Clinical PDAI score improved markedly post-tofacitinib (Pre: 3.35 [Cl 2.9-3.7; I2 = 68 %] vs Post: 2.0 [Cl 1.59-2.4; Cl = 0 %], p-value <0.001). There was a significant reduction in endoscopic PDAI score (Pre: 4.5 [Cl 3.7-5.2; I2 = 84 %] vs Post: 2.5 [Cl 1.7-3.3; Cl = 64 %], p-value < 0.001) and total PDAI score (Pre: 7.4 [Cl 5.3-9.6; I2 = 96 %] vs Post: 4.3 [Cl 2.8-5.9; Cl = 84 %], p-value < 0.001). The pooled adverse events and discontinuation rates were 30.9 % [Cl 17.5-48.5; I2=24 %] and 43 % [Cl 25-63.1; I2=40 %] respectively.

Based on this meta-analysis, tofacitinib caused statistically significant changes in PDAI scores with favourable response and remission rates. Although adverse event and discontinuation rates are high, this is similar to or less frequent than those of other biologics. Future studies are required to evaluate the long-term safety profile of tofacitinib before considering it as an effective alternative for the treatment of CP.