Postoperative Outcomes in Tofacitinib-Treated Patients With Acute Severe Ulcerative Colitis Undergoing Colectomy

Charlotte Larson; Jeffrey A Berinstein; Nicholas Tedesco; Jakob Benedict Seidelin; Pernille D Ovesen; Mathieu Uzzan; Aurélien Amiot; Alexandre Nuzzo; David Laharie; Brad D Constant; Lindsey Albenberg; Alaa El-Hussuna; Shrinivas Bishu; Shirley Cohen-Mekelburg; Peter D R Higgins; Casper Steenholdt

doi:10.1016/j.cgh.2025.01.032

Postoperative Outcomes in Tofacitinib-Treated Patients With Acute Severe Ulcerative Colitis Undergoing Colectomy

Clin Gastroenterol Hepatol. 2025 Apr 14:S1542-3565(25)00287-3. doi: 10.1016/j.cgh.2025.01.032. Online ahead of print.

Authors

Charlotte Larson¹, Jeffrey A Berinstein², Nicholas Tedesco³, Jakob Benedict Seidelin⁴, Pernille D Ovesen⁴, Mathieu Uzzan⁵, Aurélien Amiot⁶, Alexandre Nuzzo⁷, David Laharie⁸, Brad D Constant⁹, Lindsey Albenberg¹⁰, Alaa El-Hussuna¹¹, Shrinivas Bishu³, Shirley Cohen-Mekelburg³, Peter D R Higgins³, Casper Steenholdt¹²

Affiliations

¹ Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan.
² Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan; Department of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan. Electronic address: jberinst@med.umich.edu.
³ Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan; Department of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan.
⁴ Department of Gastroenterology and Hepatology, Herlev Hospital, Herlev, Denmark.
⁵ TRUE (InnovaTive theRapy for immUne disordErs), Gastroenterology Department, Henri Mondor Hospital, Fédération Hospitalo-Universitaire, Assistance Publique-Hôpitaux de Paris, Paris Est-Créteil University, Créteil, France.
⁶ EC2M3-EA7375, Department of Gastroenterology, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Paris Est-Creteil University, Creteil, France.
⁷ Department of Gastroenterology, IBD, and Nutritional Support, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, France.
⁸ Gastroenterology Department, CHU de Bordeaux, Centre Medico-Chirurgical Magellan, Hôpital Haut-Lévêque, Université de Bordeaux, Bordeaux, France; INSERM CIC 1401, Gastroenterology Department, Université de Bordeaux, Bordeaux, France.
⁹ Digestive Health Institute, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado; Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Philadelphia.
¹⁰ Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Philadelphia.
¹¹ OpenSourceResearch organization, Aalborg, Denmark.
¹² Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark.

PMID: 40239733
DOI: 10.1016/j.cgh.2025.01.032

Abstract

Background and aims: Up to 30% of patients with acute severe ulcerative colitis (ASUC) will require urgent colectomy despite initiation of intravenous corticosteroids and rescue therapies. Janus kinase inhibitors, such as tofacitinib, have emerged as an effective agent for ASUC; however, there are currently limited data evaluating the risk of postoperative complications among patients who received tofacitinib treatment for an episode of ASUC compared with infliximab.

Methods: We conducted a multicenter, retrospective, case-control study of patients hospitalized with ASUC who underwent colectomy, comparing patients treated with tofacitinib prior to colectomy with infliximab-treated controls. The primary outcome was rate of serious postoperative complications within 30 days of colectomy. Outcomes were compared between the tofacitinib-treated cases and infliximab-treated controls using multivariable regression adjusted for open surgery and cumulative corticosteroid exposure.

Results: Forty-one tofacitinib-treated patients were compared with 68 infliximab-treated patients with ASUC. Compared with tofacitinib-treated patients, infliximab-treated patients had higher overall rates of overall (44 [64.7%] vs 13 [31.7%]; P = .002) and serious (19 [27.9%] vs 3 [12%]; P = .019) postoperative complications. No significant different risk for developing serious postoperative complications (odds ratio, 0.28; 95% confidence interval, 0.06-0.96; P = .061) was observed in multivariable analysis; however, a significantly lower rate of overall postoperative complications (odds ratio, 0.38; 95% confidence interval, 0.16-0.87; P = .023) was observed in tofacitinib-treated patients compared with infliximab-treated patients.

Conclusions: We observed a significantly lower rate of overall postoperative complications in ASUC patients treated with tofacitinib compared with infliximab; however, no difference was observed in the risk for serious postoperative complications. Larger prospective trials are needed to confirm these findings.

Keywords: Acute Severe Ulcerative Colitis; Inflammatory Bowel Disease; Postoperative Complications; Tofacitinib; Ulcerative Colitis.

Published by Elsevier Inc.