Successful initial high-dose tofacitinib treatment for acute severe ulcerative colitis with steroid resistance: A case series

Abstract Background The standard therapy for acute severe ulcerative colitis (ASUC) is intravenous corticosteroids; however, 30% of UC patients do not recover with corticosteroids alone. Infliximab or cyclosporin is indicated to decrease the rates of colectomy of hospitalized ASUC patients. Although a previous study showed that moderate to severe UC had a rapid response to tofacitinib, few studies have reported the efficacy and safety of tofacitinib for ASUC.We report a case series of successful first-line treatment consisting of high-dose tofacitinib (20 mg/day) administered to ASUC patients with steroid resistance. Case presentation Patients diagnosed with ASUC at our institution between October 2018 and February 2020 were retrospectively evaluated. They were administered high dose of tofacitinib (20 mg) after they had no response to steroid therapy comprising a dose of 1 to 1.5 mg/kg/day. This study included a total of eight patients with ASUC. There were four (50%) men and four (50%) women with a median age of 47.1 years (range, 19–65 years). All patients had a median UC duration of 4 years (range, 0–20 years). Four patients had no previous history of UC.A clinical response was observed in six of the eight patients before they experienced remission. Six patients were able to avoid colectomy. One patient (patient 2) had no response; however, remission was achieved after switching from tofacitinib to infliximab. One patient (patient 6) with no response to tofacitinib underwent total colectomy. When we used tofacitinib during induction and the follow-up phase, only one patient (patient 4) experienced a major adverse event, herpes zoster, which was treated with acyclovir without stopping tofacitinib. Conclusion Clinical remission can be achieved with high probability and colectomy can be avoided by administering high-dose tofacitinib to steroid-resistant ASUC patients.