Soldera J. Navigating treatment resistance: Janus kinase inhibitors for ulcerative colitis. World J Clin Cases 2024; 12(24): 5468-5472 [DOI: 10.12998/wjcc.v12.i24.5468]
Corresponding Author of This Article
Jonathan Soldera, MD, MSc, PhD, Executive Associate Editor-in-Chief, Instructor, Acute Medicine and Gastroenterology, University of South Wales, Llantwit Road, Pontypridd, Cardiff CF37 1DL, United Kingdom. jonathansoldera@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Aug 26, 2024; 12(24): 5468-5472 Published online Aug 26, 2024. doi: 10.12998/wjcc.v12.i24.5468
Navigating treatment resistance: Janus kinase inhibitors for ulcerative colitis
Jonathan Soldera
Jonathan Soldera, Acute Medicine and Gastroenterology, University of South Wales, Cardiff CF37 1DL, United Kingdom
Author contributions: Soldera J contributed to writing and reviewing the final draft of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jonathan Soldera, MD, MSc, PhD, Executive Associate Editor-in-Chief, Instructor, Acute Medicine and Gastroenterology, University of South Wales, Llantwit Road, Pontypridd, Cardiff CF37 1DL, United Kingdom. jonathansoldera@gmail.com
Received: March 18, 2024 Revised: April 20, 2024 Accepted: May 17, 2024 Published online: August 26, 2024 Processing time: 115 Days and 8.4 Hours
Abstract
The management of refractory ulcerative colitis (UC) and acute severe UC (ASUC) is challenging due to the lack of standardized approaches in cases resistant to multiple treatments. In this editorial, I investigate the efficacy and safety of Janus kinase inhibitors, particularly upadacitinib and tofacitinib, in controlling severe and refractory disease. I highlight a notable case report by Xu et al, which explores the case of a patient with primary nonresponse to two classes of biologics and two fecal microbiota transplants who exhibited a remarkable response to upadacitinib. Furthermore, I discuss the use of tofacitinib in refractory UC and ASUC, either as monotherapy or in combination with biologics, which has shown promising response rates. Additionally, emerging evidence of upadacitinib efficacy in ASUC is presented. Overall, these cases emphasize the complex nature of managing refractory ASUC and the potential of small-molecule therapies to achieve remission. Further research is needed to refine treatment strategies for patients with treatment-resistant UC.
Core Tip: This editorial explores the efficacy and safety of Janus kinase inhibitors, specifically upadacitinib and tofacitinib, in refractory ulcerative colitis (UC) and acute severe UC (ASUC). Highlighting a compelling case report, it underscores the potential of these small-molecule therapies, either alone or in combination with biologics, to achieve and maintain disease remission. Furthermore, it emphasizes the importance of considering overlapping infections in ASUC and the need for prompt recognition by colorectal surgeons. This editorial advocates for further research to refine treatment strategies for patients with treatment-resistant UC, shedding light on promising therapeutic approaches.
