Tofacitinib in Steroid-Refractory Acute Severe Ulcerative Colitis: A Retrospective Analysis

Abstract

Introduction: Steroid-refractory acute severe ulcerative colitis (ASUC) patients are at the highest risk of colectomy. Among the available options, cyclosporine and infliximab have similar efficacy but infliximab is a costly drug and cyclosporine has multiple side effects like kidney injury, neurotoxicity, and dyselectrolytemia. Surgical management is often associated with higher morbidity. Newer oral small molecules like Janus kinase inhibitors are the ideal molecules to bridge the gap. Tofacitinib has already been extensively evaluated in patients with moderate to severe UC; however, data on ASUC treated by tofacitinib are limited. Methods: We retrospectively analyzed the data of patients with ASUC who were admitted to our hospital’s luminal gastroenterology unit between January 2021 and July 2023. Patients with ASUC who were managed with tofacitinib were included in the study. Results: Eight patients with ASUC were identified who did not respond to intravenous hydrocortisone and were treated with tofacitinib. The mean age was 39 ± 15 years and 87.5% were female. The median duration of illness was 24 months (interquartile range (IQR): 12-120 months). Seven of eight patients (87.5%) responded to oral tofacitinib 10 mg twice a day by the fifth day of treatment. The median follow-up period was six months (IQR: 1-12 months). One patient required colectomy and one patient had varicella zoster reactivation requiring treatment discontinuation. Conclusion: Tofacitinib is an attractive alternative to the currently available salvage therapy for steroid-refractory ASUC; however, long-term efficacy and risk remain to be explored.

Unveiling the Potential of JAK Inhibitors in Inflammatory Bowel Disease

“…The median follow-up period was extended to six months (IQR: 1-12 months). However, the study reported that one patient required colectomy, and another experienced varicella zoster reactivation, leading to treatment discontinuation [17]. Despite the promising initial response, this investigation underscores the need for further exploration of the long-term efficacy and associated risks of tofacitinib in the context of steroid-refractory ASUC.…”

“…In another retrospective study spanning from January 2021 to July 2023, eight patients diagnosed with ASUC who was unresponsive to intravenous hydrocortisone were analyzed for their responses to tofacitinib [17]. With a mean age of 39 ± 15 years and a predominantly female composition (87.5%), these patients displayed 87.5% positive responses to oral tofacitinib at a dosage of 10 mg twice a day within the initial five days of treatment.…”