Corticosteroid- & Biologic-Refractory Ulcerative Colitis: Tofacitinib Salvage Therapy
The following is a summary of “Tofacitinib Salvage Therapy for Children Hospitalized for Corticosteroid- and Biologic-Refractory Ulcerative Colitis” published in the December 2022 issue of Gastroenterology by Constant et al.
Despite the use of increased anti-tumor necrosis factor (TNF) biologic dosage and intravenous corticosteroids, the rate of colonoscopies following acute severe ulcerative colitis has stabilized at approximately 20%. Tofacitinib has been found in recent studies to further reduce the colectomy rate in hospitalized adult patients with ulcerative colitis who are not sensitive to corticosteroids or anti-TNF medications. There were no pediatric studies demonstrating tofacitinib’s efficacy for this use. For a study, researchers sought to characterize the tofacitinib treatment regimens and colectomy-free survival rates among juvenile patients hospitalized for refractory ulcerative colitis.
From 2018 to 2021, they conducted a retrospective single-center cohort analysis of concurrently hospitalized young patients starting tofacitinib for refractory ulcerative colitis. The main result was 90-day survival without a colectomy. Colectomy-free clinical remission, corticosteroid independence, tofacitinib medication persistence, tofacitinib-related adverse events, and surgical complications were considered secondary outcomes. Baseline traits and specifics of the order and placement of therapy used while in the hospital were documented. Kaplan-Meier curves, counts, and percentages were used to describe outcomes.
Eleven patients were eligible for inclusion. Before starting tofacitinib, all patients showed nonresponse to both intravenous corticosteroids and anti-TNF medication. The mean maximum pediatric ulcerative colitis activity index during hospitalization was 68, with a median hospital stay length of 22 days. Eight of the 11 patients had not undergone a colectomy for 90 days after being admitted to the hospital, and six had not undergone a colectomy during the median 182-day follow-up. Four of these patients were still on tofacitinib.
Tofacitinib may be a new therapy option for pediatric hospital patients with ulcerative colitis who are not responding to corticosteroids or anti-TNF. Future research is crucial to figuring out where these therapies should be placed.