Tofacitinib Induced Long-term Clinical, Endoscopic, and Histological Remission as a 6th Line Agent in Medically Refractory Ulcerative Colitis

Author(s):  
Rocio Sedano ◽  
Vipul Jairath
2021 ◽  
Vol 10 (23) ◽  
pp. 5551
Author(s):  
Panu Wetwittayakhlang ◽  
Livia Lontai ◽  
Lorant Gonczi ◽  
Petra A. Golovics ◽  
Gustavo Drügg Hahn ◽  
...  

The main therapeutic goal of ulcerative colitis (UC) is to induce and maintain remission to prevent long-term disease progression. Treat-to-target strategies, first introduced by the STRIDE consensus and updated in 2021, have shifted focus from symptomatic control toward more stringent objective endpoints. Today, patient monitoring should be based on a combination of biomarkers and clinical scores, while patient-reported outcomes could be used as short-term targets in monitoring disease activity and therapeutic response. In addition, endoscopic healing was the preferred long-term goal in UC. A Mayo endoscopic score (MES) ≤ 1 can be recommended as a minimum target. However, recent evidence suggests that more stringent endoscopic goals (MES of 0) are associated with superior outcomes. Recently, emerging data support that histological remission (HR) is a superior prognostic factor to endoscopic healing in predicting long-term remission. Despite not yet being recommended as a target, HR may become an important potential therapeutic goal in UC. However, it remains questionable if histological healing should be used as a routine assessment in addition to clinical, biomarker, and endoscopic targets in all patients. Therefore, in this review, our aim was to discuss the current evidence for the different treatment targets and their value in everyday clinical practice.


2020 ◽  
Vol 22 (1) ◽  
pp. 117-125
Author(s):  
Arianna Dal Buono ◽  
Giulia Roda ◽  
Marjorie Argollo ◽  
Kristine Paridaens ◽  
Laurent PeyrinBiroulet ◽  
...  

Background: The management of chronic conditions, above all rheumatic disease and diabetes has adopted a "treat to target" strategy where treatment aims to achieve objective outcomes; this has emerged as applicable in ulcerative colitis (UC) as well. Targets are demonstrated to prevent end-organ disfunction, specifically bowel damage and its complications, lastly colorectal cancer. Recently, the scientific community has tried to define further targets beyond those currently recommended, namely mucosal healing and clinical remission. Studies that prospectively investigated this approach in UC are scanty and a treat-to-target (T2T) algorithm is not routinely inserted in daily clinical practice. Objective: We aim to review current evidence on T2T in UC and to discuss its adoption in routine clinical practice as well as in clinical trials. Methods: A PubMed search was conducted in February 2020 to identify published papers investigating targets’ achievement rates in UC. Results: Different targets can be achieved through approved drugs for mild to moderate UC; histological remission is emerging as a robust target with respect to long-term outcomes. Conclusion: Further studies to compare a T2T strategy to the traditional care are needed, particularly in the mild to moderate spectrum of disease.


2001 ◽  
Vol 120 (5) ◽  
pp. A624-A624 ◽  
Author(s):  
J ARTS ◽  
M ZEEGERS ◽  
G DHAENS ◽  
G VANASSCHE ◽  
M HIELE ◽  
...  

2015 ◽  
Vol 17 (8) ◽  
pp. 47-50
Author(s):  
A.I. Parfenov ◽  
◽  
O.V. Knyazev ◽  
I.N. Ruchkina ◽  
◽  
...  

2020 ◽  
Author(s):  
Emma Culver ◽  
Helen K. Bungay ◽  
Margaret Betts ◽  
Colm Forde ◽  
Otto Buchel ◽  
...  

Author(s):  
Sara Santos ◽  
Verónica Gamelas ◽  
Rita Saraiva ◽  
Guilherme Simões ◽  
Joana Saiote ◽  
...  

Tofacitinib has emerged as a new option for ulcerative colitis. Its rapid absorption, metabolism, and clinical improvement make it an interesting option for rescue therapy in acute severe ulcerative colitis (ASUC), a situation with limited therapeutic options in patients with a long-term disease course and multiple drug failure. The management of ASUC in this setting becomes challenging, underlying the need for new drugs and data on their efficacy and safety. We describe 2 cases of acute episodes in which tofacitinib was used as a rescue therapy.


2020 ◽  
Vol 8 (10) ◽  
pp. 1486
Author(s):  
Andrea Quagliariello ◽  
Federica Del Chierico ◽  
Sofia Reddel ◽  
Alessandra Russo ◽  
Andrea Onetti Muda ◽  
...  

Fecal microbiota transplantation (FMT) is a promising strategy in the management of inflammatory bowel disease (IBD). The clinical effects of this practice are still largely unknown and unpredictable. In this study, two children affected by mild and moderate ulcerative colitis (UC), were pre- and post-FMT monitored for clinical conditions and gut bacterial ecology. Microbiota profiling relied on receipts’ time-point profiles, donors and control cohorts’ baseline descriptions. After FMT, the improvement of clinical conditions was recorded for both patients. After 12 months, the mild UC patient was in clinical remission, while the moderate UC patient, after 12 weeks, had a clinical worsening. Ecological analyses highlighted an increase in microbiota richness and phylogenetic distance after FMT. This increase was mainly due to Collinsella aerofaciens and Eubacterium biforme, inherited by respective donors. Moreover, a decrease of Proteus and Blautia producta, and the increment of Parabacteroides, Mogibacteriaceae, Bacteroides eggerthi, Bacteroides plebeius, Ruminococcus bromii, and BBacteroidesovatus were associated with remission of the patient’s condition. FMT results in a long-term response in mild UC, while in the moderate form there is probably need for multiple FMT administrations. FMT leads to a decrease in potential pathogens and an increase in microorganisms correlated to remission status.


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