Efficacy of Induction Therapy With High-Intensity Tofacitinib in 4 Patients With Acute Severe Ulcerative Colitis

Abstract

As many as 25% of patients diagnosed with ulcerative colitis are hospitalized with an episode of acute severe ulcerative colitis (ASUC).¹ The standard of care for patients hospitalized with ASUC relies on rapid induction with intravenous (IV) corticosteroids. Up to 30% of patients do not respond to corticosteroids alone.² Rescue therapy with infliximab or cyclosporine has been shown to reduce rates of colectomy to 20% by 90 days.^3,4 This still represents a significant rate of treatment failure, which leads to an unplanned and irreversible surgery. In recent years, increasing numbers of patients admitted with ASUC have already failed infliximab therapy, highlighting the need for additional treatment options for these patients. Tofacitinib is a rapidly acting, oral, small-molecule Janus kinase inhibitor that was recently approved by the Food and Drug Administration for treatment of ulcerative colitis.⁵ We present the first reported use of off-label, high-intensity tofacitinib in 4 patients admitted to our institution with ASUC predicted to fail medical management.

Figure 1.

(A–D) Endoscopic appearance of patients before receiving tofacitinib (Image order corresponds to patient order where A, Patient 1; B, Patient 2; C, Patient-3; D, Patient 4). (Right) CRP improvement after initiation of tofacitinib. ⁺Indicates when tofacitinib was initiated. *Indicates when the dose of tofacitinib was reduced.