Two recent case reports indicate that Tofacitinib may be useful in refractory cases of acute severe ulcerative colitis (ASUC) (JA Berinstein et al. Clin Gastroenterol Hepatol 2019; 17: 988-90) and for pyoderma gangrenosum (PG) (B Kochar et al. Clin Gastroenterol Hepatol 2019; 17: 991-93)

The case report for ASUC described 4 patients who received off-label high-intensity tofacitinib.  Initially dosing was 10 mg 3 times a day for 9 doses with subsequent transition to standard dosing.  All four patients had a rapid improvement, though one patient required a colectomy 6 months later and one patient required urgent colectomy after rapid return of symptoms when tofacitinib dose was reduced.

The case report for PG involved 3 patients -two healed with tofacitinib and one improved considerably; the latter patient required dose escalation to 10 mg twice a day.  To understand the mechanism of action further, the authors performed immunohistochemical staining from skin biopsy specimens from two patients and detected “strong staining of phosphorylated JAK-1, phosphorylated JAK-2, phosphorylated JAK-3…in the epidermis.”  Tofacitinib is an oral JAK-1/JAK-3 inhibitor.  In all of these patients, inflammatory arthritis was the indication for tofacitinib.

My take: Due to tofacitinib’s rapid onset of action as well as its rapid clearance, it is a promising agent for both acute severe ulcerative colitis and pyoderma gangrenosum.  More clinical trials are needed.

Related blog posts -Tofacitinib:

• Tofacitinib: Where does it Fit in UC Treatment Algorithm?
• AGA Guidelines on the Management of Mild-to-Moderate Ulcerative Colitis
• Tofacitinib for Induction and Maintenance of Ulcerative Colitis
• Latest on Tofacitinib for Refractory Ulcerative Colitis
• Tofacitinib –a JAK Inhibitor for UC
• Tofacitinib -Risks and Benefits in Rheumatoid Arthritis

Related blog posts -ASUC:

• Management of Acute Severe Ulcerative Colitis
• Oral Antibiotics For Refractory Inflammatory Bowel Disease | gutsandgrowth
• Management of Pediatric Ulcerative Colitis -ECCO Recommendations
• Tofacitinib -Where Does it Fit in Treatment Algorithm for Ulcerative Colitis?
• An Overlooked Finding in A Recent Severe Colitis Study
• Infliximab for children with Ulcerative Colitis
• Accelerated Infliximab Dosing in Acute … – gutsandgrowth
• Predictors of colectomy in pediatric UC | gutsandgrowth

Related blog posts -PG:

• Pyoderma Gangrenosum in Ulcerative Colitis
• Image Only: Pyoderma Gangrenosum
• February Briefs

Disclaimer: These blog posts are for educational purposes only. Specific dosing of medications/diets (along with potential adverse effects) should be confirmed by prescribing physician/nutritionist.  This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.

Image below is from an unrelated tweet.