piperidines and Pouchitis

Topics: Colitis, Ulcerative; Colonic Pouches; Crohn Disease; Humans; Piperidines; Pouchitis; Proctocolectomy, Restorative; Pyrimidines; United States

In this case series, 6 patients with chronic pouchitis (n = 3), cuffitis (n = 2), or Crohn’s-like disease of the pouch (n = 1) were treated with tofacitinib. One patient achieved clinical response; however, all patients ultimately discontinued therapy due to nonresponse or adverse events.

Topics: Colitis, Ulcerative; Colonic Pouches; Humans; Piperidines; Pouchitis; Proctocolectomy, Restorative; Pyrimidines

We describe a case of refractory pouchitis successfully treated with tofacitinib. The patient was a 20-year-old woman diagnosed with ulcerative colitis at the age of 14 years. She underwent surgery at the age of 18 years for chronic active inflammation, despite an optimal medication regimen. Ten months after surgery, she was diagnosed with pouchitis. She did not respond to conventional conservative treatment; thus, the case was considered as that of refractory chronic pouchitis. Anti-tumor necrosis factor-α (TNF-α) therapy was administered, which led to some improvement; however, pouchitis recurred. Systemic steroid and vedolizumab were also administered, but the response was unsatisfactory. Therefore, surgery was considered; however, the patient refused to undergo surgery. As identical therapies are recommended for ulcerative colitis and pouchitis, they are considered to have a common etiology. Therefore, we considered tofacitinib therapy in this case. After obtaining the patient's informed consent, tofacitinib treatment was initiated. The therapy led to improvement in her symptoms as well as in the appearance of the pouch when observed on endoscopy, and surgery was avoided. Thus, tofacitinib may be considered a therapy option for refractory chronic pouchitis.

Topics: Adolescent; Adult; Colitis, Ulcerative; Female; Humans; Piperidines; Pouchitis; Proctocolectomy, Restorative; Pyrimidines; Pyrroles; Young Adult

Topics: Adult; Aged; Female; Humans; Male; Piperidines; Pouchitis; Protein Kinase Inhibitors; Pyrimidines; Treatment Outcome

Many inflammatory bowel disease (IBD) patients do not respond to medical therapy. Tofacitinib is a first-in-class, partially selective inhibitor of Janus kinase, recently approved for treating patients with ulcerative colitis (UC). We describe our experience with the use of tofacitinib for treatment of patients with moderate-to-severe IBD.. This is a retrospective, observational study of the use of tofacitinib in IBD. Patients with medically resistant IBD were treated orally with 5 mg or 10 mg twice daily. Clinical response and adverse events were assessed at 8, 26, and 52 weeks. Objective response was assessed endoscopically, radiologically, and biochemically.. 58 patients (53 UC, 4 Crohn's, 1 pouchitis) completed at least 8 weeks of treatment with tofacitinib. 93% of the patients previously failed treatment with anti-TNF. At 8 weeks of treatment, 21 patients (36%) achieved a clinical response, and 19 (33%) achieved clinical remission. Steroid-free remission at 8 weeks was achieved in 15 patients (26%). Of the 48 patients followed for 26 weeks, 21% had clinical, steroid-free remission. Of the 26 patients followed for 12 months, 27% were in clinical, steroid-free remission. Twelve episodes of systemic infections were noted, mostly while on concomitant steroids. One episode of herpes zoster infection was noted during follow-up.. In this cohort of patients with moderate-to-severe, anti-TNF resistant IBD, tofacitinib induced clinical response in 69% of the patients. 27% were in clinical, steroid-free remission by 1 year of treatment. Tofacitinib is an effective therapeutic option for this challenging patient population.

Topics: Administration, Oral; Adult; Colitis; Colitis, Ulcerative; Drug Administration Schedule; Female; Humans; Janus Kinase Inhibitors; Male; Middle Aged; Piperidines; Pouchitis; Pyrimidines; Pyrroles; Remission Induction; Retrospective Studies; Tertiary Care Centers; Time Factors; Treatment Outcome