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. 2025 Jun 24;10(1):180-186.
doi: 10.1159/000546640. eCollection 2025 Jan-Dec.

Efficacy and Safety of Three Janus Kinase Inhibitors in Ulcerative Colitis Patients over and under 65 Years of Age: A Real-World Comparative Analysis

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

Efficacy and Safety of Three Janus Kinase Inhibitors in Ulcerative Colitis Patients over and under 65 Years of Age: A Real-World Comparative Analysis

Shintaro Akiyama et al. Inflamm Intest Dis. .

Abstract

Introduction: It remains unclear whether Janus kinase (JAK) inhibitors differ in efficacy and safety between elderly and non-elderly patients with ulcerative colitis.

Methods: We retrospectively compared outcomes between patients who started a JAK inhibitor at ≥65 years (elderly group) and those <65 years (non-elderly group).

Results: Among 228, 215, and 159 patients treated with upadacitinib, filgotinib, and tofacitinib, we identified 14, 36, and 13 elderly patients, respectively. There were no significant differences in efficacy between elderly and non-elderly patients for any of the three JAK inhibitors. The elderly group had a 3-fold higher risk of herpes zoster infection with upadacitinib or tofacitinib compared to the non-elderly group, whereas the risk with filgotinib was less than 3% in both groups. The non-elderly group had a 3-fold higher risk of acne with upadacitinib.

Conclusion: Adverse event risks with JAK inhibitors should be considered by age. Given the limitations of this study, including its retrospective design and small sample size, further studies with larger sample sizes are needed to validate our findings.

Keywords: Elderly; Janus kinase inhibitors; Ulcerative colitis.

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Conflict of interest statement

H.S., A.T., and T.S.: The Jikei University School of Medicine; M.K.: University of Tsukuba Hospital and Tokyo Women's Medical University; M.E. and S.Y.: Iwate Medical University; A.Y., K.N., and T.S.: Juntendo University School of Medicine; M.T. and K.T.: Kurume University School of Medicine; S.Y.: Kurume University School of Medicine; M.S.: Tokyo Yamate Medical Center; and T.F. have no relevant disclosures. S.A. has received honoraria (lecture fees) from AbbVie and EA Pharma. S.H. has received honoraria (lecture fees) from EA Pharma and AbbVie. K.Y. has received honoraria (lecture fees) from Takeda, Gilead, EA Pharma, and AbbVie. T.O. has received honoraria (lecture fees) from AbbVie and Takeda. M.S.: (The Jikei University School of Medicine) has received honoraria (lecture fees) from Mitsubishi-Tanabe, Takeda, Janssen, Gilead, EA Pharma, AbbVie, Mochida, Nobelpharma, Viatris, and Kissei; research grants from AbbVie, CMIC, and Shin Nippon Biomedical Laboratories; and scholarship grants from Zeria, Mochida, AbbVie, and Kissei. T.M. has received honoraria (lecture fees) from Mitsubishi-Tanabe, Takeda, Janssen, AbbVie, Gilead, Mochida, and EA Pharma and scholarship grants from Mitsubishi-Tanabe and Nippon Kayaku. R.O. has received research grants from Medical and Biological Laboratories and from EA Pharma and scholarship grants from Kyorin, Miyarisan, Zeria, and Mochida. K.T. (University of Tsukuba) has received honoraria (lecture fees) from Takeda, AbbVie, EA Pharma, and Janssen and research grants from Eli Lilly.

Figures

Fig. 1.
Fig. 1.
Bar graphs showing clinical remission, clinical response, and corticosteroid (CS)-free remission at 10 weeks, 26 weeks, and 58 weeks, as well as at the most recent follow-up, after initiation of upadacitinib (a), filgotinib (b), and tofacitinib (c). Endoscopic improvement is included at the most recent follow-up. Outcomes were stratified into patients starting a Janus kinase (JAK) inhibitor <65 years of age (non-elderly group) and patients starting a JAK inhibitor ≥65 years of age (elderly group). Data were analyzed by using a per-protocol approach. Fisher’s test showed no statistically significant differences in any of the outcomes between the non-elderly and elderly groups.
See this image and copyright information in PMC

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