Upfront tofacitinib in patients with biological-naïve ulcerative colitis - An Indian multicentric experience

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.

Rationalization of physicochemical characters of 1,5-diarylpyrazole analogs as dual (COX-2/LOX-5) inhibitors: A QSAR approach

Arachidonic acid metabolizing enzymes cyclooxygenases and lipoxygenases lead to the formation of various eicosanoids involved in variety of human diseases, like inflammation, fever, pain, rheumatic and osteoarthritis, etc. Non-steroidal anti-inflammatory drugs are useful tools in the treatment of prostaglandin mediated complications. The development of dual inhibitors may prevent a drift of arachidonic acid metabolism towards the other pathway, leading to potential side effects. Hence emphasis was focused on quantification of structure-activity relationship, with a view to delineating the influence of key COX-2/LOX-5 activity, to explore structural insights to aid the designing of safer dual inhibitors. The quantification of the structural features of 1,5-diarylpyrazole analogs with various biological activities gave some important structural insights, i.e. Hy (hydrophilic factor) and Mor17v (3D molecular representation of structure based on electron diffraction code). These two physicochemical properties may be helpful in development of more selective dual COX-2/LOX-5 inhibitors.