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Comparative Study
. 2025 Feb;61(3):524-537.
doi: 10.1111/apt.18406. Epub 2024 Nov 22.

Comparative Efficacy and Safety of Three Janus Kinase Inhibitors in Ulcerative Colitis: A Real-World Multicentre Study in Japan

Shintaro Akiyama  1 , Hiromichi Shimizu  2 , Akiko Tamura  2 , Kaoru Yokoyama  3 , Toshiyuki Sakurai  4 , Mariko Kobayashi  1 , Makoto Eizuka  5 , Shunichi Yanai  5 , Kei Nomura  6 , Tomoyoshi Shibuya  6 , Masahiro Takahara  7 , Sakiko Hiraoka  7 , Minako Sako  8 , Atsushi Yoshida  9 , Kozo Tsuruta  10 , Shinichiro Yoshioka  10 , Miki Koroku  11 , Teppei Omori  11 , Masayuki Saruta  4 , Takayuki Matsumoto  5 , Ryuichi Okamoto  2 , Kiichiro Tsuchiya  1 , Toshimitsu Fujii  2
Affiliations
Comparative Study

Comparative Efficacy and Safety of Three Janus Kinase Inhibitors in Ulcerative Colitis: A Real-World Multicentre Study in Japan

Shintaro Akiyama et al. Aliment Pharmacol Ther. 2025 Feb.

Abstract

Background: Three Janus kinase (JAK) inhibitors are approved for ulcerative colitis (UC) in Japan.

Aim: To compare the real-world efficacy and safety of these three JAK inhibitors in UC.

Methods: This was a multicentre, retrospective study of patients with UC started on JAK inhibitors. The primary outcome was clinical remission at 10, 26 and 58 weeks, and at the most recent follow-up. To compare the efficacy and safety among the JAK inhibitors, we created three matched cohorts (upadacitinib vs. filgotinib, tofacitinib vs. filgotinib and upadacitinib vs. tofacitinib) using propensity score matching.

Results: We identified 228 upadacitinib-treated patients (median follow-up 49 weeks; IQR 25-72), 215 filgotinib-treated patients (follow-up 56 weeks; IQR 17-82) and 159 tofacitinib-treated patients (follow-up 112 weeks; IQR 10-258). Clinical remission rates for upadacitinib, filgotinib and tofacitinib at the most recent follow-up were 72.8%, 50.6% and 45.8%, respectively. Over 70% of the patients previously treated with other biologics or JAK inhibitors achieved clinical remission with upadacitinib. On multivariate analysis, the number of previous advanced therapies was inversely associated with the efficacy of filgotinib and tofacitinib. Comparative analysis showed that upadacitinib-treated patients had higher efficacy and lower risk of discontinuation than patients treated with other JAK inhibitors. However, upadacitinib had a significant risk of acne.

Conclusions: Considering the particularly high efficacy of upadacitinib, even in patients with refractory UC, filgotinib or tofacitinib may be considered as an upfront JAK inhibitor before using upadacitinib.

Keywords: Janus kinase; filgotinib; tofacitinib; ulcerative colitis; upadacitinib.

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References

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