Sequential Use of High-Dose Tofacitinib After Infliximab Salvage Therapy in Acute Severe Ulcerative Colitis

• Published in: Journal of Crohn's and colitis 2022-01, Vol.16 (1), p.166-168
• Main Authors: Gilmore, Robert, Hilley, Patrick, Srinivasan, Ashish, Choy, Matthew, De Cruz, Peter
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Australia; Colitis, Ulcerative - drug therapy; Gastrointestinal Agents - therapeutic use; Humans; Infliximab - therapeutic use; Janus Kinase Inhibitors - therapeutic use; Male; Piperidines - therapeutic use; Pyrimidines - therapeutic use; Salvage Therapy; Severity of Illness Index
• ISSN: 1873-9946; 1876-4479
• DOI: 10.1093/ecco-jcc/jjab109

Abstract Background and Aims Preliminary data regarding the effectiveness of tofacitinib in acute severe ulcerative colitis [ASUC] have been presented in two previous case series. We aimed to describe the novel use of high-dose tofacitinib immediately following non-response to infliximab in the setting of steroid-refractory ASUC. Methods Five patients who received high-dose tofacitinib 10 mg three times a day immediately following non-response to infliximab for steroid-refractory ASUC were identified at an Australian tertiary inflammatory bowel disease centre. Results Four of the five patients demonstrated clinical response to high-dose tofacitinib induction during their inpatient admission, with one patient requiring colectomy owing to a lack of clinical response. At 90 days, all four initial responders remained colectomy-free, with two patients achieving combined clinical and endoscopic remission. No adverse events directly attributable to high-dose tofacitinib were identified. Conclusions High-dose tofacitinib may have a role as salvage therapy in the setting of steroid-refractory ASUC. Prospective studies are required to determine the safety and efficacy of high-dose tofacitinib to determine whether it can be routinely recommended as primary or sequential salvage therapy in the setting of steroid-refractory ASUC.