The role and prospect of tofacitinib in patients with ulcerative colitis

Abstract

a meta-analysis, intravenous infliximab is preferentially recommended in acute severe UC. 7,8 In contrast, vedolizumab and ustekinumab may be better than anti-TNFs for first-line treatment of moderate UC. They did not differ from placebo in terms of the incidence of side effects and did not require combination treatment with immunomodulators. 3,5 Tofacitinib, all Janus kinase inhibitor, is the first small-molecule drug approved as a first-line treatment for UC. In the OC-TAVE 1 and OCTAVE 2 trials in patients with severe UC, tofacitinib 10 mg demonstrated more effective clinical remission than placebo (18.5% vs. 8.2%, P = 0.007 and 16.6% vs. 3.6%, P < 0.001, respectively). 9 Tofacitinib cannot be directly compared with other biologics in the absence of head-to-head trials in patients with UC. As a result of a meta-analysis, efficacy in first-line treatment was confirmed as similar to that of other biologics. 10 However, in a recent study, tofacitinib was recommended as second-line or higher treatment when there was no response to other biologics. The main reason was safety concerns, such as serious cardiovascular events, cancer, and infections. In addition, tofacitinib is an ideal second-line treatment because, unlike biologics, the clinical response rate is similar in patients with and without biological experience.The role and position of tofacitinib as a first-line treatment for induction in patients with moderate to severe UC needs to be explored. Although it has obvious limitations in terms of safety, it can be a possible therapeutic option in the following aspects: First, it is a promising therapeutic option with rapid onset of action. Second, since it is a small molecule, there is no immunogenicity, and theoretically, loss of response does not occur. In addition, it shows a relatively high response rate even