The current role of Tofacitinib in acute severe ulcerative colitis in adult patients: A systematic review

Despite rescue therapy, acute severe ulcerative colitis (ASUC) is associated with a high risk of colectomy, while treatment options remain limited. Tofacitinib, a rapidly acting Janus Kinase (JAK) inhibitor, is gaining ground as an effective alternative treatment option for the management of acute severe ulcerative colitis, which may prevent emergency colectomy. A systematic literature search of PubMed and Embase was undertaken for studies of adult patients with ASUC treated with tofacitinib. In total, two observational studies, seven case series and five case reports incorporating 134 patients who received tofacitinib in ASUC were identified with a follow-up period ranging from 30 days to 14 months. Overall, the pooled colectomy rate was 23.9% (95% CI 16.6–31.2). The pooled 90-day and 6-month colectomy free rate were 79.9% (95% CI 73.1–86.7) and 71.6% (95% CI 64–79.2) respectively. The most frequent adverse event was C. Difficile infection. Tofacitinib appears to be a promising option for the treatment of ASUC. Randomized clinical trials are required to further access the efficacy, safety and optimal dose of tofacitinib in cases of ASUC.