ISG Hybrid Winter Meeting 2022
IBD E-Poster - Second Prize
Beaumont Hospital, Dublin
A real world review of dose escalation and treatment failure of Tofacitinib in ulcerative colitis in a Tertiary Referral Centre
A real world review of dose escalation and treatment failure ofTofacitinib in ulcerative colitis in a Tertiary Referral Centre
Dr Maeve Clarke, Ms Caroline Lardener, Professor Stephen Patchett, Professor Karen Boland, Dr Neasa Mc Gettigan.
Gastroenterology Department, Beaumont Hospital, Dublin, Ireland
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.
This study aimed to examine the maintenance dosage of Tofacitinib in a real world setting and to identify predictor variables of accelerated dosing.
A retrospective observational study was carried out using Minitab for statistical analysis, p <0.05 denoted statistical significance.
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).
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.