TBA (22W158)

A real world review of dose escalation and treatment failure ofTofacitinib in ulcerative colitis in a Tertiary Referral Centre

Author(s)

Dr Maeve Clarke, Ms Caroline Lardener, Professor Stephen Patchett, Professor Karen Boland, Dr Neasa Mc Gettigan.

Department(s)/Institutions

Gastroenterology Department, Beaumont Hospital, Dublin, Ireland

Introduction

Tofacitinib is an oral JAK inhibitor licensed in ulcerative colitis following inadequate response/intolerance to conventional therapy. It is prescribed at 10mg BD for eight weeks as induction followed by 5mg BD maintenance.

Aims/Background

This study aimed to examine the maintenance dosage of Tofacitinib in a real world setting and to identify predictor variables of accelerated dosing.

Method

A retrospective observational study was carried out using Minitab for statistical analysis, p <0.05 denoted statistical significance.

Results

32 patients prescribed Tofacitinib were included. Male patients n=17(53%). 50% had pancolitis (n= 16, of whom 56% were on 10mg BD maintenance) 34% had left sided disease, 9% proctitis. 16 patients in total (50%) were prescribed 10mg BD maintenance and 50% 5mg BD. 9/32 (28%) failed Tofacitinib and 1 patient was prescribed dual treatment with Ustekinumab. Of the failed cohort, n=5/9 received higher dosing (10mg BD). 2 accelerated patients successfully lowered their maintenance to 5mg BD after a short interval. Mean CRP was non-statistically higher in the 10mg BD group (20.6 vs 12,p=0.37), endoscopic mayo score was the same (2.67 vs 2.67,p=1.0). 15 patients had ≥2 biologics previously which did not influence higher dosing or drug failure (p=0.43,p=0.45). CRP and FCP were not associated with treatment failure (p=0.34,p=0.73).

Conclusions

Tofacitinib is an effective agent in the treatment of UC, particularly those who have failed biologics. Over 70% of our cohort remain in clinical remission. Further analysis is required to identify suitable patients for dose escalation and predictor variables for non- responders to optimise treatment.