Tofacitinib in Acute Severe Ulcerative Colitis: Case Series and a Systematic Review

Jena, Anuraag; Mishra, Shubhra; Sachan, Anurag; Singh, Harjeet; Singh, Anupam; Sharma, Vishal

doi:10.1093/ibd/izab087

Cited by 25 publications

(10 citation statements)

References 6 publications

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“…Clinical trials and real-word data suggest that tofacitinib is effective for induction and maintenance of remission in patients with active ulcerative colitis. [1][2][3] The use of tofacitinib has been associated with an increased risk of infections, especially herpes zoster reactivation. 1,2 Increased risk of tuberculosis (TB) has been reported in patients with rheumatoid arthritis treated with tofacitinib.…”

mentioning

confidence: 99%

Tubercular Pleural Effusion in a Patient of Ulcerative Colitis Treated With Tofacitinib

Mishra

Singh

Kopp

et al. 2021

Inflammatory Bowel Diseases

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confidence: 99%

Tubercular Pleural Effusion in a Patient of Ulcerative Colitis Treated With Tofacitinib

Mishra

Singh

Kopp

et al. 2021

Inflammatory Bowel Diseases

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“…However, data regarding the effectiveness and safety of third‐line rescue treatment following IFX or CyA failure are very sparse. This lack of knowledge is most noticeable when new therapeutic agents are used as third‐line rescue treatment 14–16 . Currently, European Crohn's and Colitis Organisation (ECCO) guidelines recommend colectomy for ASUC refractory to IFX or CyA but also suggest consideration for a third‐line rescue in carefully selected patients in centres with adequate expertise 17 .…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and safety of a third‐line rescue treatment for acute severe ulcerative colitis refractory to infliximab or ciclosporin (REASUC study)

García,

Riestra,

Amiot

et al. 2024

Aliment Pharmacol Ther

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SummaryBackgroundThe advent of new therapeutic agents and the improvement of supporting care might change the management of acute severe ulcerative colitis (ASUC) and avoid colectomy.AimsTo evaluate the colectomy‐free survival and safety of a third‐line treatment in patients with ASUC refractory to intravenous steroids and who failed either infliximab or ciclosporin.MethodsMulticentre retrospective cohort study of patients with ASUC refractory to intravenous steroids who had failed infliximab or ciclosporin and received a third‐line treatment during the same hospitalisation. Patients who stopped second‐line treatment due to disease activity or adverse events (AEs) were eligible. We assessed short‐term colectomy‐free survival by logistic regression analysis. Kaplan–Meier curves and Cox regression models were used for long‐term assessment.ResultsAmong 78 patients, 32 received infliximab and 46 ciclosporin as second‐line rescue treatment. Third‐line treatment was infliximab in 45 (58%), ciclosporin in 17 (22%), tofacitinib in 13 (17%) and ustekinumab in 3 (3.8%). Colectomy was performed in 29 patients (37%) during follow‐up (median 21 weeks). Of the 78 patients, 32 and 18 were in clinical remission at, respectively, 12 and 52 weeks. At the last visit, 25 patients were still on third‐line rescue treatment, while 12 had stopped it due to clinical remission. AEs were reported in 26 (33%) patients. Two patients died (2.6%), including one following colectomy.ConclusionThird‐line rescue treatment avoided colectomy in over half of the patients with ASUC and may be considered a therapeutic strategy.

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“… 6-9 This is supported by previous findings, in which TFB was proved to be effective in steroid-refractory ASUC in biologic-experienced patients. 6 , 7 , 10 , 11 However, safety concerns have been raised, 12 notably the higher incidence of deep vein thrombosis and pulmonary embolism compared with tumor necrosis factor α inhibitors 13 ; nonetheless, the higher incidence of thrombotic events in patients with rheumatoid arthritis was not reproduced in UC studies. 14 Both safety and efficacy data are lacking in real-life clinical studies.…”

Section: Introductionmentioning

confidence: 99%

Real-Life Efficacy of Tofacitinib in Various Situations in Ulcerative Colitis: A Retrospective Worldwide Multicenter Collaborative Study

Resál,

Bacsur,

Keresztes

et al. 2023

Inflammatory Bowel Diseases

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Background and Aims Tofacitinib (TFB) appears to be effective in the treatment of ulcerative colitis (UC); however, available real-world studies are limited by cohort size. TFB could be an option in the treatment of acute severe ulcerative colitis (ASUC). We aimed to investigate efficacy and safety of TFB in moderate-to-severe colitis and ASUC. Methods This retrospective, international cohort study enrolling UC patients with ≥6-week follow-up period was conducted from February 1 to July 31, 2022. Indications were categorized as ASUC and chronic activity (CA). Baseline demographic and clinical data were obtained. Steroid-free remission (SFR), colectomy, and safety data were analyzed. Results A total of 391 UC patients (median age 38 [interquartile range, 28-47] years; follow-up period 26 [interquartile range, 14-52] weeks) were included. A total of 27.1% received TFB in ASUC. SFR rates were 23.7% (ASUC: 26.0%, CA: 22.8%) at week 12 and 41.1% (ASUC: 34.2%, CA: 43.5%) at week 52. The baseline partial Mayo score (odds ratio [OR], 0.850; P = .006) was negatively associated with week 12 SFR, while biologic-naïve patients (OR, 2.078; P = .04) more likely achieved week 52 SFR. The colectomy rate at week 52 was higher in ASUC group (17.6% vs 5.7%; P < .001) and decreased with age (OR, 0.94; P = .013). A total of 67 adverse events were reported, and 17.9% resulted in cessation of TFB. One case of thromboembolic event was reported. Conclusions TFB is effective in both studied indications. TFB treatment resulted in high rates of SFR in the short and long terms. Higher baseline disease activity and previous biological therapies decreased efficacy. No new adverse event signals were found.

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Tofacitinib in Acute Severe Ulcerative Colitis: Case Series and a Systematic Review

Cited by 25 publications

References 6 publications

Tubercular Pleural Effusion in a Patient of Ulcerative Colitis Treated With Tofacitinib

Tubercular Pleural Effusion in a Patient of Ulcerative Colitis Treated With Tofacitinib

Effectiveness and safety of a third‐line rescue treatment for acute severe ulcerative colitis refractory to infliximab or ciclosporin (REASUC study)

Real-Life Efficacy of Tofacitinib in Various Situations in Ulcerative Colitis: A Retrospective Worldwide Multicenter Collaborative Study

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