T Straamijer et al. Clin Gastroenterol Hepatol 2023; 21: 182-191. Open Access! Superior Effectiveness of Tofacitinib Compared to Vedolizumab in Anti-TNF-experienced Ulcerative Colitis Patients: A Nationwide Dutch Registry Study
Methods: Adults with ulcerative colitis (UC) previously who failed anti-TNF treatment and initiated vedolizumab (n=83) or tofacitinib (n=65) treatment were identified in the Initiative on Crohn and Colitis Registry in the Netherlands.
Key findings (Vedolizumab is in gray):
- There was no difference in infection rate or severe adverse events.
My take: Coupled with more recent reassuring safety data on JAK inhibitors, this study makes a strong case for positioning Tofacitinib (or other JAK inhibitor) earlier in patients with moderate-to-severe ulcerative colitis. Given that vedolizumab outperformed adalimumab in a head-to-head study, this indicates that tofacitinib is a very effective therapy.
Related article: B Chen et al. Gastroenterology 2022; 163: 1555-1568. Efficacy and Safety of Ivarmacitinib in Patients With Moderate-to-Severe, Active, Ulcerative Colitis: A Phase II Study This phase 2 study with 146 patients examined the effectiveness of the selective JAK inhibitor Ivarmacitinib found a week 8 clinical response in 46% of those receiving 8 mg per day. The week 8 clinical remission rate was 22%-24% in the treatment groups compared to 5% in the placebo group.
Related blog posts:
- Treatments for “Bad” Inflammatory Bowel Disease (Part 2) & Reassuring Data on Tofacitinib
- Vedolizumab vs Adalimumab: Histology Outcomes from Varsity Trial
- Vedolizumab versus Adalimumab for Ulcerative Colitis (part 2)
- Vedolizumab More Effective Than Adalimumab for Ulcerative Colitis
- IBD Updates: Probability of Needing a Stoma with Crohn’s Disease, “CEASE” anti-TNF study, Extending Tofacitinib Response Time
- Increased Risk, Increased Reward (possibly) with Tofacitinib
- A New FDA Warning for Tofacitinib
- “Tofacitinib: A Jak of All Trades”
- How Quickly Does Tofacitinib Work for Ulcerative Colitis?
- FDA Slaps Restrictions on JAK Inhibitors Over Serious Safety Risks (2021)
- A New FDA Warning for Tofacitinib (2021)
- AGA Guidelines: Moderate to Severe Ulcerative Colitis
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