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Dalal RS, Sharma PP, Bains K, Pruce JC, Allegretti JR. Clinical and Endoscopic Outcomes Through 78 Weeks of Tofacitinib Therapy for Ulcerative Colitis in a US Cohort. Inflamm Bowel Dis 2024; 30:1707-1713. [PMID: 37843044 PMCID: PMC11447005 DOI: 10.1093/ibd/izad242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Tofacitinib is an oral JAK inhibitor for the treatment of ulcerative colitis (UC). We assessed outcomes through 78 weeks of tofacitinib therapy for UC in a real-world setting. METHODS This retrospective cohort study included adults initiating tofacitinib for UC from May 1, 2018, to April 1, 2021, at a large academic center in the United States. The primary outcome was steroid-free clinical remission at 78 (+/-4) weeks (SFCR 78; simple clinical colitis activity index ≤2 with no corticosteroid use within 30 days). The secondary outcome was tofacitinib discontinuation due to nonresponse (treatment persistence). Additional outcomes were endoscopic response/remission and adverse events (AEs). RESULTS Seventy-three patients initiated tofacitinib, with a median follow-up of 88 weeks. Among patients with available data, 31 of 60 (51.7%) achieved SFCR 78, 21 of 47 (44.7%) achieved endoscopic remission during follow-up, and 25 of 73 (34.2%) discontinued tofacitinib during follow-up due to nonresponse (including 11 patients who required colectomy). Nineteen AEs were reported among 15 patients during follow-up: shingles (n = 4, all without documented vaccinations), deep venous thrombosis (n = 2), elevated liver enzymes (n = 2), skin abscess (n = 2), pneumonia (n = 2), possible miscarriage (n = 2), norovirus (n = 1), COVID-19 (n = 1), lymphopenia (n = 1), Clostridioides difficile infection (n = 1), and heart block (n = 1). One patient discontinued therapy due to an AE (elevated liver enzymes), and no deaths occurred. CONCLUSION Tofacitinib treatment was effective in achieving SFCR for the majority of patients with UC through 78 weeks. Adverse events were consistent with the known safety profile of tofacitinib, and AEs requiring discontinuation were rare. Due to limitations regarding sample size, larger studies are needed to confirm these findings.
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Affiliation(s)
- Rahul S Dalal
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Kanwal Bains
- Department of Nutrition, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jordan C Pruce
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessica R Allegretti
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Wu Q, Li T, Deng F, Yao X, Chen X, Jiang Q, Ding X. Assessing anorectal function in patients with recurrent ulcerative colitis. Int J Colorectal Dis 2024; 39:110. [PMID: 39009899 PMCID: PMC11249410 DOI: 10.1007/s00384-024-04680-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE Ulcerative colitis (UC) is an inflammatory bowel disease with an unclear etiology that can lead to irreversible changes in distal colonic function in chronic patients. This study investigated anorectal function in recurrent UC patients and identified influencing factors. METHODS This prospective study enrolled 33 recurrent UC patients and 40 newly diagnosed patients from January 2019 to December 2022. Data collection included clinical records, scores, and anorectal function assessments. Regression analyses were used to identify factors impacting anorectal function. RESULTS Recurrent UC patients had higher baseline CRP and fecal calprotectin levels, increased anxiety and depression, and more severe fecal incontinence. They also had lower BMIs, serum Hb and albumin (ALB) levels, and Inflammatory Bowel Disease Questionnaire scores than did initial-onset UC patients. Multivariate linear regression analysis revealed that long disease duration (coef. - 0.376, P < 0.001) and high fecal calprotectin level (coef. - 0.656, P < 0.001) independently influenced the initial sensation threshold in recurrent UC patients. Additionally, high fecal calprotectin (coef. - 0.073, P = 0.013) and high Zung Self-Rating Anxiety Scale score (coef. - 0.489, P = 0.001) were identified as two independent determinants of the defecation volume threshold. For the defecation urgency threshold, the independent factors included high disease duration (coef. - 0.358, P = 0.017) and high fecal calprotectin level (coef. - 0.499, P = 0.001). Similarly, the sole independent factor identified for the maximum capacity threshold was high fecal calprotectin (coef. - 0.691, P = 0.001). CONCLUSION Recurrent UC patients had increased rectal sensitivity and compromised anorectal function, which significantly impacted quality of life. Proactively managing the disease, reducing UC relapses, and addressing anxiety are effective measures for improving anorectal function in these patients.
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Affiliation(s)
- Qiaoyan Wu
- Department of Gastroenterology, The First Affiliated Hospital of Ningbo University, No. 59, Liuting Street, Zhejiang Province, Ningbo, 315010, China
- Ningbo Key Laboratory of Translational Medicine Research On Gastroenterology and Hepatology, No. 59, Liuting Street, Zhejiang Province, Ningbo, 315010, China
| | - Tongyu Li
- Department of Hematology, The First Affiliated Hospital of Ningbo University, No. 59, Liuting Street, Zhejiang Province, Ningbo, 315010, China
| | - Fenglian Deng
- Department of Gastroenterology, The First Affiliated Hospital of Ningbo University, No. 59, Liuting Street, Zhejiang Province, Ningbo, 315010, China
- Ningbo Key Laboratory of Translational Medicine Research On Gastroenterology and Hepatology, No. 59, Liuting Street, Zhejiang Province, Ningbo, 315010, China
| | - Xuejie Yao
- Department of Gastroenterology, The First Affiliated Hospital of Ningbo University, No. 59, Liuting Street, Zhejiang Province, Ningbo, 315010, China
- Ningbo Key Laboratory of Translational Medicine Research On Gastroenterology and Hepatology, No. 59, Liuting Street, Zhejiang Province, Ningbo, 315010, China
| | - Xueqin Chen
- Hospital Quality Management Office, The First Affiliated Hospital of Ningbo University, No. 59, Liuting Street, Zhejiang Province, Ningbo, 315010, China
| | - Qi Jiang
- Department of Gastroenterology, The First Affiliated Hospital of Ningbo University, No. 59, Liuting Street, Zhejiang Province, Ningbo, 315010, China.
- Ningbo Key Laboratory of Translational Medicine Research On Gastroenterology and Hepatology, No. 59, Liuting Street, Zhejiang Province, Ningbo, 315010, China.
| | - Xiaoyun Ding
- Department of Gastroenterology, The First Affiliated Hospital of Ningbo University, No. 59, Liuting Street, Zhejiang Province, Ningbo, 315010, China.
- Ningbo Key Laboratory of Translational Medicine Research On Gastroenterology and Hepatology, No. 59, Liuting Street, Zhejiang Province, Ningbo, 315010, China.
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Shimizu H, Aonuma Y, Hibiya S, Kawamoto A, Takenaka K, Fujii T, Saito E, Nagahori M, Ohtsuka K, Okamoto R. Long-term efficacy and safety of tofacitinib in patients with ulcerative colitis: 3-year results from a real-world study. Intest Res 2024; 22:369-377. [PMID: 39009375 PMCID: PMC11309816 DOI: 10.5217/ir.2023.00194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/12/2024] [Accepted: 03/22/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND/AIMS The efficacy and safety of tofacitinib for the treatment of refractory ulcerative colitis (UC) has been demonstrated in clinical trials. Although, a series of reports with real-world evidence of its short-term efficacy and safety profiles have already been published, reports of long-term real-world data have been limited. We aimed to show our 3-year evidence on the clinical use of tofacitinib for the treatment of UC, focusing on its efficacy and safety profiles. METHODS A retrospective observational study was conducted on patients who started tofacitinib for active refractory UC at our hospital. The primary outcome was the retention rate until 156 weeks after initiating tofacitinib. The secondary outcomes were short-term efficacy at 4, 8, and 12 weeks; long-term efficacy at 52, 104, and 156 weeks; prognostic factors related to the cumulative retention rate; loss of response; and safety profile, including adverse events. RESULTS Forty-six patients who were able to be monitored for up to 156 weeks after tofacitinib initiation, were enrolled in this study. Continuation of tofacitinib was possible until 156 weeks in 54.3%, with > 50% response rates and > 40% remission rates. Among patients in whom response or remission was achieved and tofacitinib was deescalated after 8 weeks of induction treatment, 54.3% experienced relapse but were successfully rescued by and retained on reinduction treatment, except for 1 patient. No serious AEs were observed in the study. CONCLUSIONS Tofacitinib is effective and safe as long-term treatment in a refractory cohort of UC patients in real-world clinical practice.
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Affiliation(s)
- Hiromichi Shimizu
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuko Aonuma
- First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Shuji Hibiya
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ami Kawamoto
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kento Takenaka
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshimitsu Fujii
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eiko Saito
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masakazu Nagahori
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuo Ohtsuka
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryuichi Okamoto
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
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Giri S, Bhrugumalla S, Kamuni A, Mishra D, Pati GK, Agrawal D, Verma G, Wagh R, Chauhan S, Ingle M, Chandnani S, Jain S, Rathi PM, Shukla A, Kale A. Upfront tofacitinib in patients with biological-naïve ulcerative colitis - An Indian multicentric experience. Indian J Gastroenterol 2024; 43:237-243. [PMID: 37726491 DOI: 10.1007/s12664-023-01434-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/18/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVES Tofacitinib is a Janus Kinase inhibitor used for treating moderate to severe ulcerative colitis (UC), mainly after the failure of biological therapy. There is a paucity of data on the outcome of tofacitinib in biological-naïve UC patients. The present study was aimed at analyzing the safety and efficacy of tofacitinib in biological-naïve Indian patients with UC. METHODS The present study retrospectively evaluated consecutive patients with biological-naïve moderate-to-severe active UC from six tertiary care centers in India receiving tofacitinib from September 2020 to September 2022. Clinical remission or response assessment was based on partial Mayo score (PMS) calculated at baseline and weeks eight, 16 and 24. RESULTS Total 47 cases (57.4% male, median age: 32 years) were included. After eight weeks of therapy, 33 (70.2%) achieved clinical remission and eight (17.0%) had a primary failure. The baseline serum albumin at treatment initiation was the only independent predictor of remission at eight weeks (Odds ratio: 11.560, 95% CI: 1.478 - 90.404), but not at 16 weeks. By 24 weeks, 59.6% (28/47) of the patients were in remission and 29.8% (14/47) had stopped tofacitinib either due to failure (27.6%) or adverse events (AEs) (2.1%). Among the 47 patients, 10 (21.2%) cases developed AEs during follow-up, including two tuberculosis (4.2%), one cytomegalovirus (CMV) colitis (2.1%) and one herpes zoster (2.1%). Four patients with infection required temporary drug discontinuations. One required permanent discontinuation (mania). CONCLUSION Upfront tofacitinib is effective in biologic-naïve Indian patients with moderate-severe UC. Further randomized studies are required to validate the study findings.
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Affiliation(s)
- Suprabhat Giri
- Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, 500 082, India
| | - Sukanya Bhrugumalla
- Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, 500 082, India
| | - Abhishek Kamuni
- Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, 500 082, India
| | - Debakanta Mishra
- Department of Gastroenterology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, 751 003, India
| | - Girish Kumar Pati
- Department of Gastroenterology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, 751 003, India
| | - Dhiraj Agrawal
- Department of Gastroenterology, PACE Hospital, Hyderabad, 500 081, India
| | - Govind Verma
- Department of Gastroenterology, PACE Hospital, Hyderabad, 500 081, India
| | - Rohit Wagh
- Department of Gastroenterology, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, 400 022, India
| | - Shamshersingh Chauhan
- Department of Gastroenterology, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, 400 022, India
| | - Meghraj Ingle
- Department of Gastroenterology, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, 400 022, India
| | - Sanjay Chandnani
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, 400 008, India
| | - Shubham Jain
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, 400 008, India
| | - Pravin M Rathi
- Department of Gastroenterology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, 400 008, India
| | - Akash Shukla
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, 9th Floor, New OPD Building, Parel, Mumbai, 400 012, India
| | - Aditya Kale
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, 9th Floor, New OPD Building, Parel, Mumbai, 400 012, India.
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5
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Harindranath S, Singh A. Tofacitinib in ulcerative colitis - Small molecule but large effect. Dig Liver Dis 2024; 56:371-372. [PMID: 37867020 DOI: 10.1016/j.dld.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Affiliation(s)
- Sidharth Harindranath
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India.
| | - Ankita Singh
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India
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Shin SH, Oh K, Hong SN, Lee J, Oh SJ, Kim ES, Na SY, Kang SB, Koh SJ, Bang KB, Jung SA, Jung SH, Kim KO, Park SH, Yang SK, Choi CH, Ye BD. Real-life effectiveness and safety of tofacitinib treatment in patients with ulcerative colitis: a KASID multicenter cohort study. Therap Adv Gastroenterol 2023; 16:17562848231154103. [PMID: 36950251 PMCID: PMC10026122 DOI: 10.1177/17562848231154103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 01/13/2023] [Indexed: 03/24/2023] Open
Abstract
Background Tofacitinib is a small molecule that inhibits Janus kinase and has been reported to be effective in Western patients with ulcerative colitis (UC). However, the real-life data on tofacitinib in Asian UC patients are limited. Objective To investigate the real-life effectiveness and safety of tofacitinib induction and maintenance treatment in Korean patients with UC. Design This was a retrospective study on patients with UC who received tofacitinib treatment at 12 hospitals in Korea between January 2018 and November 2020. Methods Clinical remission at week 52, defined as a partial Mayo score of ⩽2 with a combined rectal bleeding subscore and stool frequency subscore of ⩽1, was used as the primary outcome. Adverse events (AEs), including herpes zoster and deep vein thrombosis, were also evaluated. Results A total of 148 patients with UC were started on tofacitinib. Clinical remission rates of 60.6%, 54.9%, and 52.8% were reported at weeks 16, 24, and 52, respectively. Clinical response rates of 71.8%, 67.6%, and 59.9% were reported at weeks 16, 24, and 52, respectively. Endoscopic remission rates at weeks 16 and 52 were 52.4% and 30.8% based on the Mayo endoscopic subscore and 20.7% and 15.2% based on the UC endoscopic index of severity (UCEIS), respectively. A higher UCEIS at baseline was negatively associated with clinical response [adjusted odds ratio (aOR): 0.774, p = 0.029] and corticosteroid-free clinical response (aOR: 0.782, p = 0.035) at week 52. AEs occurred in 19 patients (12.8%) and serious AEs in 12 patients (8.1%). Herpes zoster occurred in four patients (2.7%). One patient (0.7%) suffered from deep vein thrombosis. Conclusions Tofacitinib was an effective induction and maintenance treatment with an acceptable safety profile in Korean patients with UC. Plain language summary Real-life effectiveness and safety of tofacitinib treatment in Korean patients with ulcerative colitis Ulcerative colitis (UC) is an idiopathic, chronic inflammatory disorder of the colonic mucosa that usually presents with bloody diarrhea and abdominal pain. Tofacitinib is a small molecule that inhibits Janus kinase and has been reported to be effective in Western patients with UC. However, real-life data on the effectiveness of tofacitinib in Asian patients with UC are limited. To investigate the real-life effectiveness and safety of tofacitinib treatment in Korean patients with UC, we retrospectively analyzed the data of 148 patients with UC who received tofacitinib treatment at 12 hospitals in Korea between January 2018 and November 2020. Clinical remission (i.e. complete improvement of symptoms) was achieved in 60.6% and 52.8% of patients at weeks 16 and 52, respectively. Endoscopic remission was achieved in 52.4% and 30.8% of patients at weeks 16 and 52, respectively. A higher baseline score of the UC endoscopic index of severity, which is one of the endoscopic indices that evaluate the severity of inflammation of the colon, was negatively associated with clinical response (i.e. partial improvement of symptoms). Adverse events (AEs) including herpes zoster and deep vein thrombosis occurred in 19 patients (12.8%) and serious AEs occurred in 12 patients (8.1%). Our real-life study shows that tofacitinib is a clinically effective treatment for Korean patients with UC, and the incidence of AEs was also similar to those observed in other real-world studies.
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Affiliation(s)
- Seung Hwan Shin
- Department of Gastroenterology, University of
Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyunghwan Oh
- Department of Gastroenterology, University of
Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sung Noh Hong
- Division of Gastroenterology, Department of
Medicine, Samsung Medical Center, Sungkyunkwan University School of
Medicine, Seoul, Korea
| | - Jungbok Lee
- Department of Biostatistics and Clinical
Epidemiology, Asan Medical Center, Seoul, Korea
| | - Shin Ju Oh
- Department of Gastroenterology, Kyung Hee
University College of Medicine, Seoul, Korea
| | - Eun Soo Kim
- Division of Gastroenterology and Hepatology,
Department of Internal Medicine, School of Medicine, Kyungpook National
University, Daegu, Korea
| | - Soo-Young Na
- Department of Internal Medicine, Incheon St.
Mary’s Hospital, College of Medicine, The Catholic University of Korea,
Incheon, Korea
| | - Sang-Bum Kang
- Department of Internal Medicine, College of
Medicine, Daejeon St. Mary’s Hospital, The Catholic University of Korea,
Daejeon, Korea
| | - Seong-Joon Koh
- Department of Internal Medicine and Liver
Research Institute, Seoul National University College of Medicine, Seoul,
Korea
| | - Ki Bae Bang
- Department of Internal Medicine, Dankook
University College of Medicine, Cheonan, Korea
| | - Sung-Ae Jung
- Department of Internal Medicine, Ewha Womans
University College of Medicine, Seoul, Korea
| | - Sung Hoon Jung
- Department of Internal Medicine, Eunpyeong St.
Mary’s Hospital, College of Medicine, The Catholic University of Korea,
Seoul, Korea
| | - Kyeong Ok Kim
- Division of Gastroenterology and Hepatology,
Department of Internal Medicine, Yeungnam University College of Medicine,
Daegu, Korea
| | - Sang Hyoung Park
- Department of Gastroenterology and
Inflammatory Bowel Disease Center, University of Ulsan College of Medicine,
Asan Medical Center, Seoul, Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology and
Inflammatory Bowel Disease Center, University of Ulsan College of Medicine,
Asan Medical Center, Seoul, Korea
| | - Chang Hwan Choi
- Department of Internal Medicine, Chung-Ang
University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul 06973,
Korea
| | - Byong Duk Ye
- Department of Gastroenterology and
Inflammatory Bowel Disease Center, Asan Medical Center, University of Ulsan
College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South
Korea
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Mishra S, Jena A, Kakadiya R, Sharma V, Ahuja V. Positioning of tofacitinib in treatment of ulcerative colitis: a global perspective. Expert Rev Gastroenterol Hepatol 2022; 16:737-752. [PMID: 35875997 DOI: 10.1080/17474124.2022.2106216] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Tofacitinib has emerged as a useful drug for the treatment of ulcerative colitis (UC). AREAS COVERED There is an unmet need for cost-effective, non-immunogenic drugs with a safe adverse effect profile to treat patients with ulcerative colitis. In the present review, we evaluate the available literature to inform the appropriate positioning of tofacitinib in the current drug landscape and identify subsets where its use should be done with caution. EXPERT OPINION Tofacitinib is helpful in the treatment of patients where the standard conventional or biological therapies have failed or were not tolerated. With lower costs of the generic drug than the biologicals (or biosimilars), it could be an important therapy in low- to middle-income countries. The risk of infections, especially Herpes Zoster and tuberculosis, needs to be addressed before initiation. Tofacitinib should be avoided in patients with venous thromboembolism and cardiovascular disease risk factors. Due to limited evidence, the use is not recommended in pregnancy, while it should be used with caution in elderly citizens. Future trials should look into the head-to-head comparison of tofacitinib with biologicals. The role of tofacitinib in acute severe colitis needs evaluation with comparative trials with current standards of care.
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Affiliation(s)
- Shubhra Mishra
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals, Hyderabad, India
| | - Anuraag Jena
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rinkalben Kakadiya
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vineet Ahuja
- Department of Gastroenterology, All India Institute of Medical Education and Research, New Delhi, India
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Long MD, Afzali A, Fischer M, Hudesman D, Abdalla M, McCabe R, Cohen BL, Ungaro RC, Harlan W, Hanson J, Konijeti G, Polyak S, Ritter T, Salzberg B, Seminerio J, English E, Zhang X, Sharma PP, Herfarth HH. Tofacitinib Response in Ulcerative Colitis (TOUR): Early Response After Initiation of Tofacitinib Therapy in a Real-world Setting. Inflamm Bowel Dis 2022; 29:570-578. [PMID: 35700276 PMCID: PMC10069660 DOI: 10.1093/ibd/izac121] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Tofacitinib is an oral, small-molecule JAK inhibitor for the treatment of ulcerative colitis (UC). Using a novel electronic reporting tool, we aimed to prospectively describe the onset of tofacitinib efficacy during induction therapy in a real-world study. METHODS Patient-reported outcome data (PROs) including the simple clinical colitis activity index (SCCAI), PRO Measurement Identification Systems (PROMIS) measures, and adverse events were collected daily for the first 14 days and at day 28 and 56. Paired t tests and P for trend were utilized to compare changes in SCCAI over time. Bivariate analyses and logistic regression models were performed to describe response (SCCAI <5) and remission (SCCAI ≤2) by clinical factors. RESULTS Of all included patients (n = 96), 67% had failed ≥2 biologics, and 61.5% were on concomitant steroids. Starting at day 3, PROs showed significant and persistent decline of the mean SCCAI (-1.1, P < 000.1) including significantly lower SCCAI subscores for stool frequency (-0.3; P < .003), bleeding (-0.3; P < .0002) and urgency (-0.2; P < .001). Steroid-free remission at day 14, 28, and 56 was achieved in 25%, 30.2%, and 29.2% of patients, respectively. Neither prior biologics nor endoscopic severity were independently predictive of response or remission in multivariate models. Numeric improvements in all PROMIS measures (anxiety, depression, social satisfaction) were seen through day 56. Rates of discontinuation due to adverse events were low. CONCLUSIONS In this prospective real-world study, tofacitinib resulted in a rapid and persistent improvement in UC disease activity PROs. The safety findings were consistent with the established safety profile of tofacitinib.
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Affiliation(s)
- Millie D Long
- University of North Carolina at Chapel Hill, Division of Gastroenterology and Hepatology, Chapel Hill, NC, USA
| | - Anita Afzali
- Ohio State University, Division of Gastroenterology and Hepatology, Columbus, OH, USA
| | - Monika Fischer
- Indiana University, Division of Gastroenterology and Hepatology, Indianapolis, IN, USA
| | | | - Maisa Abdalla
- University of Rochester, Division of Gastroenterology and Hepatology, Rochester, NY, USA
| | | | - Benjamin L Cohen
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ryan C Ungaro
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Will Harlan
- Digestive Health Partners, Ashville, NC, USA
| | - John Hanson
- Atrium Health Gastroenterology and Hepatology, Charlotte, NC, USA
| | | | - Steven Polyak
- University of Iowa, Division of Gastroenterology and Hepatology, Iowa City, IA, USA
| | | | | | - Jennifer Seminerio
- Division of Digestive Diseases and Nutrition, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Emily English
- University of North Carolina at Chapel Hill, Division of Gastroenterology and Hepatology, Chapel Hill, NC, USA
| | - Xian Zhang
- University of North Carolina at Chapel Hill, Division of Gastroenterology and Hepatology, Chapel Hill, NC, USA
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Hernández Martínez A, Navajas Hernández P, Martín Rodríguez MDM, Lázaro Sáez M, Olmedo Martín R, Núñez Ortiz A, Argüelles Arias F, Fernández Cano MDC, Gallardo Sánchez F, Marín Pedrosa S, González García J, Vázquez Morón JM. Efficacy and safety of tofacitinib in the treatment of ulcerative colitis: real-life experience in Andalusia. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2022; 114:516-521. [PMID: 35000397 DOI: 10.17235/reed.2022.8380/2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Tofacitinib is a Janus kinase inhibitor approved for the treatment of moderate-severe ulcerative colitis (UC). In the present study we aimed to evaluate its efficacy in a real-life setting. METHODS Retrospective and multicenter observational study including UC patients treated with tofacitinib. Short and long-term treatment effectiveness, treatment survival, need for dose escalation and safety are analyzed. Clinical response and remission were defined in accordance with the partial Mayo score. RESULTS Seventy-four patients were included, 98.3% of whom had received prior biological treatment: 55.4% with 3 or more biologicals and up to 64.9% with 2 or 3 different mechanisms of action. Clinical remission and response rates were 37.8% and 77% at 8 weeks, and 41.8% and 70.1% at 16 weeks. Of non-responders at 8 weeks, 37,5% achieved a delayed clinical response at 16 weeks. Mean treatment duration was 19 months (95% CI: 16-22), with a treatment survival of 56% at 28 months, and remission and response rates at 24 months of 53.8% and 61.5%. Twenty-three treatments were withdrawn, most of them (18) during the induction period. There were adverse events in a quarter of the patients; only 4 were severe and led to treatment discontinuation. CONCLUSION Tofacitinib demonstrates in clinical practice its efficacy to induce and maintain clinical response in treatment-refractory UC patients, with an acceptable safety profile.
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