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Tofacitinib use in ulcerative colitis: An expert consensus for day-to-day clinical practice

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Abstract

Rising number of inflammatory bowel disease (IBD) cases in developing countries necessitate clear guidance for clinicians for the appropriate use of advanced therapies. An expert consensus document was generated to guide the usage of tofacitinib, a Janus kinase inhibitor, in ulcerative colitis. Tofacitinib is a useful agent for the induction and maintenance of remission in ulcerative colitis. It can be used in the setting of biological failure or even steroid-dependent and thiopurine refractory disease. Typically, the induction dose is 10 mg BD orally. Usually, clinical response is evident within eight weeks of therapy. In those with clinical response, the dose can be reduced from 10 mg BD to 5 mg BD. Tofacitinib should be avoided or used cautiously in the elderly, patients with cardiovascular co-morbidity, uncontrolled cardiac risk factors, previous thrombotic episodes and those at high risk for venous thrombosis or previous malignancy. Baseline evaluation should include testing for and management of hepatitis B infection and latent tuberculosis. Where feasible, it is prudent to ensure complete adult vaccination, including Herpes zoster, before starting tofacitinib. The use of tofacitinib may be associated with an increased risk of infections such as herpes zoster and tuberculosis reactivation. Maternal exposure to tofacitinib should be avoided during pre-conception, pregnancy, and lactation. There is emerging evidence of tofacitinib in acute severe colitis, although the exact positioning (first-line with steroids or second-line) is uncertain.

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Authors and Affiliations

  1. Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Mindspace Road, Gachibowli, Hyderabad, 500 032, India

    Rupa Banerjee, Rajendra Patel, Partha Pal, Nalini Raghunathan, Dhanush Mekala, G. V. Rao, Manu Tandon, Shubhankar Godbole & D. Nageshwar Reddy

  2. Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160 012, India

    Vishal Sharma & Usha Dutta

  3. IMS and SUM Hospital, K8, Kalinga Nagar, Bhubaneswar, 751 003, India

    Anuraag Jena

  4. BLK Institute of Digestive Science, BLK-Max Super Speciality Hospital, Pusa Road, New Delhi, 110 005, India

    Ajay Kumar

  5. Dayanand Medical College and Hospital, Civil Lines, Tagore Nagar, Ludhiana, 141 001, India

    Ajit Sood & Vandana Midha

  6. Medanta Hospital, CH Baktawar Singh Road, Medicity, Islampur Colony, Sector 38, Gurugram, 122 001, India

    Amarender S. Puri

  7. Dispur Hospital, Dispur, Manik Nagar, Guwahati, 781 006, India

    Bhabhadev Goswami

  8. Hinduja Hospital, 8-12, Swatantryaveer Savarkar Road, Mahim West, Mahim, Mumbai, 400 016, India

    Devendra Desai

  9. Aster Hospital, Kuttisahib Road Cheranelloor, South Chittoor, Kochi, 682 027, India

    G. N. Ramesh

  10. Yashoda Hospitals, 6-3-905, Raj Bhavan Road, Matha Nagar, Somajiguda, Hyderabad, 500 082, India

    Kiran Peddi

  11. Lisie Institute of Gastroenterology, Cochin, Lisie Hospital Road, North Kaloor, Kaloor, Ernakulam, 682 018, India

    Mathew Philip

  12. National Institute of Medical Sciences, Kalwad Kalan and Khurd, Jaipur, 303 121, India

    Shobna Bhatia

  13. Paras Hospitals, Sec-43, Sushant Lok, Gurugram, 122 002, India

    Sumit Bhatia

  14. Apollo Institute of Gastrosciences and Liver, Apollo Multispecialty Hospitals, 58, Canal Circular Road, Kadapara, Phool Bagan, Kankurgachi, Kolkata, 700 054, India

    Uday C. Ghoshal

  15. VGM Hospital, 2100, Trichy Road, Coimbatore, 641 005, India

    V. G. Mohan Prasad

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Corresponding author

Correspondence to Rupa Banerjee.

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Competing interests

RB, VS, RP, AJ, PP, NR, AK, AS, ASP, BG, DD, DM, GNR, GVR, KP, MP, MT, SB, SG, SuB, UCG, UD, VM, VGMP and DNR declare that they have no conflict of interest.

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Banerjee, R., Sharma, V., Patel, R. et al. Tofacitinib use in ulcerative colitis: An expert consensus for day-to-day clinical practice. Indian J Gastroenterol 43, 22–35 (2024). https://doi.org/10.1007/s12664-023-01507-9

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