Real-world evidence of tofacitinib effectiveness and safety in patients with refractory ulcerative colitis

Loriane Lair-Mehiri, Carmen Stefanescu, Thibaut Vaysse, David Laharie, Xavier Roblin, Isabelle Rosa, Xavier Treton, Vered Abitbol, Aurélien Amiot, Guillaume Bouguen, Nina Dib, Mathurin Fumery, Benjamin Pariente, Franck Carbonnel, Laurent Peyrin-Biroulet, Marion Simon, Stéphanie Viennot, Yoram Bouhnik
Digestive and Liver Disease 2019 November 12

BACKGROUND: Phase III trials demonstrated effectiveness of tofacitinib, an oral Janus kinase inhibitor, to induce and maintain remission in patients with moderate-to-severe active ulcerative colitis (UC).

AIMS: We report the real-world effectiveness and safety of tofacitinib in patients with UC in France.

METHODS: From February 2017 to December 2018, we performed a national French cohort study, which included all consecutive patients with an active UC refractory to anti-TNF and vedolizumab, who received tofacitinib. Outcomes were survival without colectomy, survival without tofacitinib discontinuation and steroid-free clinical remission at weeks 14, 24 and 48.

RESULTS: Thirty-eight patients were included, with a median follow-up of 41.5 (18.5-56.8) weeks. Survival without colectomy was 77% [95% confidence interval (95%CI): 59.3-87.9] at week 24 and 70% (95%CI: 50.9-82.8) at week 48. Survival without treatment discontinuation was 70% (95%CI: 52.6-82.3) at week 24. Steroid-free clinical remission was observed in 13 (34%) patients at week 48. Adverse events occurred in 14 (37%) patients, including 6 severe adverse events and three herpes zoster infections.

CONCLUSION: In a highly refractory UC population, one third of patients treated with tofacitinib achieved steroid-free clinical remission at week 14 and 70% of patients avoided colectomy at one year, with an acceptable safety profile. These data confirm tofacitinib effectiveness in UC, especially after multiple biologic failures.

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