Tofacitinib better than azathioprine as maintenance in steroid-responsive acute severe UC

In patients with steroid-responsive acute severe ulcerative colitis (UC), maintenance therapy with tofacitinib appears to be more effective at maintaining remission when compared with azathioprine, according to a study.

Researchers looked at 115 adult patients (median age 38 years, 46.95 percent female) with acute severe UC who had responded to intravenous corticosteroids. A total of 65 patients who received maintenance azathioprine were propensity-score matched to 50 who received maintenance tofacitinib.

Outcomes such as rehospitalization, corticosteroid reuse, therapeutic escalation, and colectomy were recorded. Cumulative event-free survival at 1 year was the primary endpoint. Safety was also assessed in the two treatment arms.

The cumulative probability of event-free survival at 1 year was significantly higher with tofacitinib than with azathioprine (75.0 percent vs 44.0 percent; p=0.01). Compared with patients on azathioprine, those on tofacitinib had significantly less frequent rehospitalization (0 percent vs 15.4 percent; p=0.003) and therapeutic escalation events (2.0 percent vs 13.8 percent; p=0.02).

Furthermore, patients on maintenance tofacitinib were more likely to achieve symptomatic remission (40.0 percent vs 23.1 percent; p=0.05) at 1 year compared with those on maintenance azathioprine. However, no significant between-group difference was seen in the number of patients with combined symptomatic and biomarker remission (22.0 percent vs 16.9 percent; p=0.49).

Adverse events occurred in 47.8 percent of patients overall, with none requiring discontinuation of therapy.