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Ribaldone DG, Testa G, Verstockt B, Molnar T, Savarino E, Schmidt C, Vieujean S, Teich N, Meianu C, Juillerat P, Grellier N, Lobaton T. Treatment of Antibiotic Refractory Chronic Pouchitis With JAK Inhibitors and S1P Receptor Modulators: An ECCO CONFER Multicentre Case Series. J Crohns Colitis 2024; 18:720-726. [PMID: 37965867 DOI: 10.1093/ecco-jcc/jjad194] [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: 10/10/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND AND AIMS Data regarding the effectiveness and safety of Janus kinase [JAK] inhibitors and sphingosine-1-phosphate [S1P] receptor modulators in antibiotic refractory chronic pouchitis [CARP] are lacking. METHODS This ECCO-CONFER project retrospectively collected data for JAK inhibitor or S1P receptor modulator treatments for CARP with at least 3 months of follow-up. The outcomes included corticosteroid- and antibiotic-free clinical response and remission at 3 and 12 months, and trends in modified pouchitis disease activity index [mPDAI], endoscopic PDAI, C-reactive protein, and calprotectin. RESULTS Seventeen treatments in 15 patients were evaluated. Previous pouchitis treatments included infliximab [5/15], adalimumab [4/15], vedolizumab [9/15], and ustekinumab [5/15]. Pooling data on JAK inhibitors [eight tofacitinib, one filgotinib, and six upadacitinib] after 3 months [T3], steroid- and antibiotic-free clinical response was achieved in 53.3% [8/15], and steroid- and antibiotic-free clinical remission was achieved in 40% [6/15]. Of the patients with at least 12 months of follow-up, steroid- and antibiotic-free clinical response was achieved in 50% [3/6] and remission in one patient [16.7%], endoscopic response in 50% [3/6], and endoscopic remission in 50% [3/6]. Of the two ozanimod treatments at T3, steroid- and antibiotic-free clinical response was achieved in one patient, without remission; both discontinued ozanimod before T12. No side effects were reported. CONCLUSIONS Small molecules may represent a suitable option for CARP refractory to multiple biologics, deserving further investigation.
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Affiliation(s)
| | - Giulia Testa
- Gastroenterology-U, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | | | - Edoardo Savarino
- Division of Gastroenterology, Department of Surgery Oncology and Gastroenterology DiSCOG, University of Padova, Padova, Italy
| | - Carsten Schmidt
- Medical Clinic II, Hospital Fulda, Fulda, Germany
- Medical Faculty of the Friedrich Schiller University, Jena, Germany
| | - Sophie Vieujean
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Niels Teich
- Medical Faculty of the Friedrich Schiller University, Jena, Germany
- Gastroenterology Practice, Leipzig, Germany
| | - Corina Meianu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Gastroenterology Department, Fundeni Clinical Institute, Bucharest, Romania
| | - Pascal Juillerat
- Clinic for Visceral Surgery and Medicine, Department of Gastroenterology, Bern University Hospital, Berne, Switzerland
- Crohn and Colitis Center, Gastro-enterologie Beaulieu SA, Lausanne, Switzerland
| | - Nathan Grellier
- Hepato-Gastroenterology Department, University Hospital of Poitiers, Poitiers, France
| | - Triana Lobaton
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium; Department of Gastroenterology, University Hospital Ghent, Ghent, Belgium
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Xu X, Jiang JW, Lu BY, Li XX. Upadacitinib for refractory ulcerative colitis with primary nonresponse to infliximab and vedolizumab: A case report. World J Clin Cases 2024; 12:1685-1690. [PMID: 38576732 PMCID: PMC10989418 DOI: 10.12998/wjcc.v12.i9.1685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/22/2024] [Accepted: 02/28/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Many patients with ulcerative colitis (UC) do not respond well to, or tolerate conventional and biological therapies. There is currently no consensus on the treatment of refractory UC. Studies have demonstrated that the selective Janus kinase 1 inhibitor upadacitinib, a small-molecule drug, is effective and safe for treating UC. However, no studies have revealed that upadacitinib is effective in treating refractory UC with primary nonresponse to infliximab and vedolizumab. CASE SUMMARY We report the case of a 44-year-old male patient with a chief complaint of bloody diarrhoea with mucus and pus, in addition to dizziness. The patient had recurrent disease after receiving mesalazine, prednisone, azathioprine, infliximab and vedolizumab over four years. Based on the endoscopic findings and pathological biopsy, the patient was diagnosed with refractory UC. In particular, the patient showed primary nonresponse to infliximab and vedolizumab. Based on the patient's history and recurrent disease, we decided to administer upadacitinib. During hospitalisation, the patient was received upadacitinib under our guidance. Eight weeks after the initiation of upadacitinib treatment, the patient's symptoms and endoscopic findings improved significantly. No notable adverse reactions have been reported to date. CONCLUSION Our case report suggests that upadacitinib may represent a valuable strategy for treating refractory UC with primary nonresponse.
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Affiliation(s)
- Xuan Xu
- Department of Gastroenterology, Shenzhen Hospital, Southern Medical University, Shenzhen 518100, Guangdong Province, China
- The First Clinical Medical School, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Jing-Wen Jiang
- Department of Gastroenterology, Shenzhen Hospital, Southern Medical University, Shenzhen 518100, Guangdong Province, China
- The First Clinical Medical School, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Bing-Yun Lu
- Department of Gastroenterology, Shenzhen Hospital, Southern Medical University, Shenzhen 518100, Guangdong Province, China
| | - Xia-Xi Li
- Department of Gastroenterology, Shenzhen Hospital, Southern Medical University, Shenzhen 518100, Guangdong Province, China
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Fanizza J, D'Amico F, Lauri G, Martinez-Dominguez SJ, Allocca M, Furfaro F, Zilli A, Fiorino G, Parigi TL, Radice S, Peyrin-Biroulet L, Danese S. The role of filgotinib in ulcerative colitis and Crohn's disease. Immunotherapy 2024; 16:59-74. [PMID: 38009327 DOI: 10.2217/imt-2023-0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023] Open
Abstract
Filgotinib is an oral small molecule that selectively inhibits JAK1. It is already approved for the treatment of moderately to severely active ulcerative colitis (UC). Ongoing studies are evaluating the efficacy and safety of filgotinib in Crohn's disease (CD). The purpose of this review is to summarize the available data regarding filgotinib in the management of UC and CD. We used Pubmed, Embase and clinicaltrials.gov websites to search all available data and currently ongoing studies regarding the efficacy and safety of filgotinib in inflammatory bowel diseases. Filgotinib is an effective and safe drug for the management of biologic-naive and biologic-experienced patients with moderate-to-severe UC. The same efficacy results have not been achieved in CD.
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Affiliation(s)
- Jacopo Fanizza
- Department of Gastroenterology & Endoscopy, IRCCS San Raffaele Hospital & Vita-Salute San Raffaele University, Milan, Italy
| | - Ferdinando D'Amico
- Department of Gastroenterology & Endoscopy, IRCCS San Raffaele Hospital & Vita-Salute San Raffaele University, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Gaetano Lauri
- Department of Gastroenterology & Endoscopy, IRCCS San Raffaele Hospital & Vita-Salute San Raffaele University, Milan, Italy
| | - Samuel J Martinez-Dominguez
- Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Aragón Health Research Institute, Zaragoza, Spain; School of Medicine, University of Zaragoza, Spain
| | - Mariangela Allocca
- Department of Gastroenterology & Endoscopy, IRCCS San Raffaele Hospital & Vita-Salute San Raffaele University, Milan, Italy
| | - Federica Furfaro
- Department of Gastroenterology & Endoscopy, IRCCS San Raffaele Hospital & Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandra Zilli
- Department of Gastroenterology & Endoscopy, IRCCS San Raffaele Hospital & Vita-Salute San Raffaele University, Milan, Italy
| | - Gionata Fiorino
- Department of Gastroenterology & Endoscopy, IRCCS San Raffaele Hospital & Vita-Salute San Raffaele University, Milan, Italy
| | - Tommaso Lorenzo Parigi
- Department of Gastroenterology & Endoscopy, IRCCS San Raffaele Hospital & Vita-Salute San Raffaele University, Milan, Italy
| | - Simona Radice
- Department of Gastroenterology & Endoscopy, IRCCS San Raffaele Hospital & Vita-Salute San Raffaele University, Milan, Italy
| | - Laurent Peyrin-Biroulet
- University of Lorraine, Inserm, NGERE, F-54000 Nancy, France
- Department of Gastroenterology, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
| | - Silvio Danese
- Department of Gastroenterology & Endoscopy, IRCCS San Raffaele Hospital & Vita-Salute San Raffaele University, Milan, Italy
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Dalal RS, Kallumkal G, Cabral HJ, Bachour S, Barnes EL, Allegretti JR. Clinical and Endoscopic Outcomes After Upadacitinib Induction for Ulcerative Colitis: A Multicenter Retrospective Cohort Study. Inflamm Bowel Dis 2023:izad155. [PMID: 37498971 DOI: 10.1093/ibd/izad155] [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: 06/09/2023] [Indexed: 07/29/2023]
Abstract
In this retrospective cohort study, upadacitinib induction was effective in achieving steroid-free clinical remission of ulcerative colitis for the majority of patients. Adverse events leading to treatment discontinuation were rare and were consistent with the known safety profile of upadacitinib.
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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, Massachusetts, USA
| | - Govind Kallumkal
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Heidy J Cabral
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Salam Bachour
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Edward L Barnes
- Division of Gastroenterology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jessica R Allegretti
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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