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Multimodal Quantitative Phase Imaging with Digital Holographic Microscopy Accurately Assesses Intestinal Inflammation and Epithelial Wound Healing
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Sequential Janus Kinase Inhibitor Switching in Ulcerative Colitis Patients Maintaining Remission: A Multicenter

Genta Uchida1, Tsunaki Sawada2, Masanao Nakamura3

  • 1Department of Gastroenterology and Hepatology, Toyota Kosei Hospital, Toyota, Japan.

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Switching ulcerative colitis patients from JAK inhibitors like tofacitinib or upadacitinib to filgotinib may offer a viable intermediate maintenance strategy. This approach balances disease control with potential safety benefits before complete drug withdrawal.

Keywords:
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Area of Science:

  • Gastroenterology
  • Immunology
  • Pharmacology

Background:

  • Long-term Janus kinase (JAK) inhibitor use in ulcerative colitis (UC) raises safety concerns, necessitating effective "exit strategies."
  • Tofacitinib (TOF) and upadacitinib (UPA) are JAK inhibitors used for UC, but their long-term safety profiles require careful consideration.
  • Identifying alternative maintenance strategies is crucial for managing UC while minimizing risks.

Purpose of the Study:

  • To evaluate the efficacy and safety of switching from tofacitinib (TOF) or upadacitinib (UPA) to filgotinib (FIL) in UC patients.
  • To assess the feasibility of filgotinib as an intermediate maintenance therapy in UC patients previously treated with other JAK inhibitors.
  • To determine the non-relapse rate and adverse events associated with this sequential treatment approach.

Main Methods:

  • Retrospective, multicenter study design.
  • Inclusion of 13 ulcerative colitis patients in clinical remission on TOF or UPA who switched to FIL.
  • Primary endpoint: cumulative non-relapse rate over a median follow-up of 679 days.

Main Results:

  • Symptomatic relapse occurred in 53.8% of patients.
  • One-year cumulative non-relapse rates were 71.4% for the TOF-switch group and 31.3% for the UPA-switch group.
  • Relapses were often managed by dose adjustments or topical therapies; no serious adverse events were reported.

Conclusions:

  • Sequential switching to filgotinib (FIL) can serve as a practical intermediate maintenance strategy for UC patients.
  • This strategy may help maintain disease control while potentially offering improved safety compared to continuous use of other JAK inhibitors.
  • Filgotinib represents a potential option for patients transitioning before complete drug cessation.