Is there a role for use of JAK inhibitors instead of corticosteroids to induce clinical remission in those with severe ulcerative colitis?

Tofacitinib and upadacitinib are specifically approved for the treatment of moderately to severely active ulcerative colitis (UC), and both had steroid-sparing endpoints in their clinical trial programs. However, so do many of our newer therapies for UC. Both agents have demonstrated efficacy within...

Yes, due to the rapid onset of action for the JAK inhibitors such as upadacitinib and tofacitinib, we are increasingly considering holding steroids and initiating JAKi inhibitors in patients with severe ulcerative colitis. For inpatients with acute severe ulcerative colitis, my practice is still to ...

Our systematic review found that upadacitinib induces rapid and sustained improvement in acute severe ulcerative colitis.

Damianos et al., PMID 39186564

There is a growing body of evidence that this approach can be successful. We started using them in people who had failed an inpatient course of steroids and now some people start that instead of steroids whether inpatient or outpatient, sometimes briefly pushing the dose.

Because with some as you kn...

While JAK inhibitors have shown benefit in limited and uncontrolled settings, I don’t use them as the singular modality. As it is recommended for aTNF failures, its use in biologic-naive patients may be problematic if the outcome is adverse. We have only some data regarding the risk of JAK inhibitor...