Sequential Janus Kinase Inhibitor Switching in Ulcerative Colitis Patients Maintaining Remission: A Multicenter...

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.