Tofacitinib Appears Well Tolerated and Effective for the Treatment of Patients with Refractory Crohn's Disease.

Abstract

BACKGROUND:

Active Crohn's disease increases the risk of strictures, fistulas, and abscesses. Less than 30% of patients with Crohn's disease achieve endoscopic remission on any therapy. Tofacitinib may be a therapeutic option for patients with refractory Crohn's disease.

AIMS:

We aimed to evaluate the safety and effectiveness of off-label tofacitinib for refractory Crohn's disease.

METHODS:

We retrospectively assessed adverse events and clinical/endoscopic response after therapy.

RESULTS:

Forty-four patients were included in the safety analysis and 35 were included in the clinical and/or endoscopic assessments. The mean age was 41.8 years and the mean disease duration was 17.4 years. All patients had prior biologic exposure. Adverse events were reported in 52.3% of patients; 13.6% had ≥ 1 serious adverse event after a median 54.6 weeks of treatment. Seventy percent achieved clinical response after a mean 29.4 (SD 15.1) weeks, and 33.3% achieved clinical remission after a mean 33.4 (SD 17.6) weeks of therapy. Endoscopic improvement occurred in 25.0%, endoscopic remission in 12.5%, and endoscopic healing in 4.2% of patients after a mean 52.0 (SD 15.0) weeks of therapy. The mean Simple Endoscopic Score in Crohn's disease significantly improved from 23.1 ± 3.7 to 18.0 ± 13.7 after treatment (P = .02).

CONCLUSIONS:

In the short term, tofacitinib appears well tolerated. The most common adverse event was minor infection. One serious infection and one colorectal cancer occurred. While half of patients reported adverse events, this likely reflects the severe refractory disease in this population and no new safety events were observed. Tofacitinib achieved clinical and endoscopic improvement in some patients with refractory Crohn's disease. Further research is needed to understand the long-term safety and efficacy of tofacitinib in Crohn's disease.

• Authors: Scott David Lee, Anand Singla, Jason Harper, Mitra Barahimi, Jeffrey Jacobs, Kendra J Kamp, Kindra Dawn Clark-Snustad
• Journal: Digestive diseases and sciences (Dig Dis Sci) Vol. 67 Issue 8 Pg. 4043-4048 (08 2022) ISSN: 1573-2568 [Electronic] United States
• PMID: 35288831 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: © 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Chemical References

• Piperidines
• Pyrimidines
• tofacitinib

Topics

• Adult
• Crohn Disease (diagnosis, drug therapy)
• Humans
• Piperidines (adverse effects)
• Pyrimidines (adverse effects)
• Remission Induction
• Retrospective Studies