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Original Article Propensity score-matched real-world comparative treatment outcomes of Janus kinase inhibitors for ulcerative colitis in patients with and without prior exposure to anti-tumor necrosis factor α antibody
Maiko Ikenouchi1orcid , Hirokazu Fukui1orcid , Soichi Yagi1orcid , Akira Nogami2orcid , Koji Kaku1orcid , Toshiyuki Sato1orcid , Mikio Kawai1orcid , Koji Kamikozuru1orcid , Yoko Yokoyama1orcid , Tetsuya Takagawa3orcid , Toshihiko Tomita1orcid , Taku Kobayashi2orcid , Shinichiro Shinzaki1orcid

DOI: https://doi.org/10.5217/ir.2024.00148 [Epub ahead of print]
Published online: February 3, 2025
1Department of Gastroenterology, Faculty of Medicine, Hyogo Medical University, Hyogo, Japan
2Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
3Center for Clinical Research and Education, Hyogo Medical University, Hyogo, Japan
Corresponding author:  Shinichiro Shinzaki,
Email: sh-shinzaki@hyo-med.ac.jp
Received: 22 September 2024   • Revised: 18 November 2024   • Accepted: 20 November 2024
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Background/Aims
Tofacitinib (TFB), filgotinib (FIL), and upadacitinib (UPA) are Janus kinase (JAK) inhibitors approved for moderate-to-severe ulcerative colitis (UC). The appropriate positioning of each JAK inhibitor in the treatment algorithm, however, is unclear. Furthermore, real-world efficacy of JAK inhibitors for patients with UC and prior anti-tumor necrosis factor α antibody (aTNF) treatment are not fully investigated. We compared the efficacy and safety of 3 JAK inhibitors in patients with UC, considering their prior aTNF exposure.
Methods
A retrospective study was conducted in patients with UC who started TFB, FIL, or UPA at 2 academic centers. This propensity score-matched cohort study assessed the effectiveness of the 3 JAK inhibitors for UC in patients with and without prior aTNF exposure, comparing steroid-free clinical remission and response rates after 8 weeks.
Results
Among 274 patients who met the inclusion criteria, 145 experienced aTNF exposure (TFB: 59.2%, 100/169; FIL: 34.5%, 20/58; UPA: 53.2%, 25/47). Based on propensity score-matching, UPA led to a higher steroid-free clinical remission rates than TFB (adjusted odds ratio [aOR], 5.57; 95% confidence interval [CI], 1.42–21.90) or FIL (aOR, 9.00; 95% CI, 1.42–57.10) in patients exposed to aTNF. Steroid-free clinical remission and clinical response rates did not differ significantly between each group in patients non-exposed to aTNF. The incidence of adverse events was slightly higher with UPA than TFB or FIL.
Conclusions
UPA may be more effective for UC than TFB or FIL, especially in patients with previous aTNF exposure, although consideration should be given to adverse events.


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