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:
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