Acute severe ulcerative colitis: efficacy and safety of JAK inhibitors

Acute severe ulcerative colitis is a potentially life-threatening manifestation of ulcerative colitis requiring hospitalization and prompt intervention. Despite corticosteroids being the cornerstone of initial therapy, 30-40% of patients exhibit steroid-refractory disease and require rescue treatment with infliximab or cyclosporine, with colectomy rates remaining substantial. The introduction of Janus kinase inhibitors, including tofacitinib, upadacitinib, and filgotinib, has expanded the therapeutic options for ulcerative colitis, offering a rapid onset of action and oral administration.

This review summarizes the current evidence on the use of Janus kinase inhibitors in acute severe ulcerative colitis, with a primary focus on tofacitinib and upadacitinib with multiple retrospective studies and one randomized controlled trial suggesting efficacy in inducing clinical response and reducing colectomy rates. A comprehensive search of PubMed, Embase, and Scopus identified observational retrospective and prospective studies and randomized trials on JAK inhibitors in ulcerative colitis.

While safety concerns persist, available evidence suggests an acceptable safety profile. Janus kinase inhibitors may represent a viable alternative in acute severe ulcerative colitis.