For patients with ASUC whose disease has not responded to a corticosteroid, the standard rescue therapy is either cyclosporine or infliximab, followed by colectomy when a case is refractory to or unsuitable for rescue medical therapy. Sequential salvage therapy, the use of an additional advanced medical therapy in the second line before colectomy, is not generally recommended due to safety concerns with sequential use of infliximab and cyclosporine. However, JAK inhibitors such as tofacitinib and upadacitinib have a number of characteristics that may \u201csuggest a potential role as an alternate therapy in steroid refractory ASUC,\u201d Robert Gilmore, MBChB, of Mater Hospital in Brisbane, Australia, and colleagues explained. Data on JAK inhibitors for ASUC, either as frontline or rescue therapy, are limited and follow-up durations are short.<\/p>\n
Dr. Gilmore and colleagues conducted a nationwide, multicenter retrospective cohort study to evaluate the use of JAK inhibitors for ASUC. The study included patients who had received either upadacitinib or tofacitinib at 13 inflammatory bowel disease centers in Australia. Of the 150 patients included, 77 (51%) received upadacitinib and 73 (49%) received tofacitinib; 103 (69%) received JAK inhibitors as rescue therapy, and 47 (31%), as sequential salvage therapy. Of the 103 patients who received rescue therapy, 53 (51%) received upadacitinib and 50 (49%) received tofacitinib. Of the 47 patients who received sequential salvage therapy, 24 (51%) received upadacitinib and 23 (49%) received tofacitinib. Outcomes were assessed at admission, week 8, week 16, and week 52. The primary outcome was cumulative rate of colectomy by week 52.<\/p>\n
At week 52, the cumulative rate of colectomy was 33% overall, including 23.4% of those who received upadacitinib and 42.5% of those who received tofacitinib. This represents a significantly lower rate of colectomy among those who received upadacitinib compared with those who received tofacitinib. However, there was no statistically significant difference in the cumulative rate of colectomy between the upadacitinib group and the tofacitinib group at any of the other time points (admission, week 8, or week 16). Although there was no statistically significant difference in the rates of colectomy with sequential salvage therapy compared with rescue therapy, there was a numerically higher rate of colectomy with sequential salvage therapy at all time points.<\/p>\n
Clinical remission was achieved in 54% of patients at week 8, 48% of patients at week 16, and 46% of patients at week 52. There were higher rates of both clinical and biochemical remission among those who received upadacitinib than those who received tofacitinib at week 16 and week 52 (no significant difference at week 8). In addition, rescue therapy had significantly higher rates of both clinical and biochemical remission than sequential salvage therapy at week 16 and week 52 (no significant difference at week 8).<\/p>\n
Overall, 21% of patients experienced an adverse event. The most common adverse events were acne, rash, and nasopharyngitis. Seven dose interruptions and three dose discontinuations occurred because of adverse events. Serious adverse events occurred in 7% of patients. There was no significant difference in the rates of adverse events between upadacitinib and tofacitinib or between rescue and sequential salvage therapy.<\/p>\n
Dr. Gilmore and colleagues concluded, \u201cJAK inhibitors were effective for ASUC \u2026 with an acceptable safety profile,\u201d but went on to note that \u201cprospective studies are needed to better define optimal patient selection, treatment sequencing, and supportive care approaches for JAK inhibitor use in ASUC.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"For patients with ASUC whose disease has not responded to a corticosteroid, the standard rescue therapy is either…\n","protected":false},"author":2,"featured_media":908682,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[10],"tags":[64,63,137],"class_list":["post-908681","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health","tag-au","tag-australia","tag-health"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/posts\/908681","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/comments?post=908681"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/posts\/908681\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/media\/908682"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/media?parent=908681"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/categories?post=908681"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/tags?post=908681"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}