New Study Reveals Comparable Postoperative Risks of Tofacitinib and Biologics in Ulcerative Colitis Patients

In a significant breakthrough, a recent multicenter retrospective study has shed light on the postoperative outcomes of ulcerative colitis (UC) patients treated with tofacitinib versus biologics prior to total colectomy. Researchers found that Preoperative tofacitinib was as safe as biologics in patients with UC undergoing colectomy. The findings, published in The American Journal of Gastroenterology offers valuable insights into the comparative safety profiles of these treatment modalities, potentially reshaping clinical decision-making in UC management.

Patients with ulcerative colitis (UC) who are treated with immunosuppressive drugs face a significant risk of colectomy, a surgical procedure to remove the colon. Hence, researchers set out to examine the risk of postoperative complications associated with exposure to tofacitinib, prior to colectomy, and compare it with the risk associated with biologics, commonly used to treat UC in patients undergoing colectomy for medically refractory disease by conducting a multicenter, retrospective, observational study. 
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Notably, the patient pool comprised 301 individuals across multiple centers treated with tofacitinib, anti-tumor necrosis factor-α agents, vedolizumab, and ustekinumab. Primary outcomes focused on the occurrence of any complication within both early (30 days) and late (90 days) postoperative periods, while secondary outcomes examined specific complications such as infections, sepsis, surgical site issues, venous thromboembolic events (VTE), hospital readmissions, and redo surgeries.
Findings:
  • The study revealed no significant disparities in outcomes between patients treated with tofacitinib and those receiving biologics.
  • Although there were slight variations, such as a marginally higher incidence of early VTE with anti-tumor necrosis factor-α agents and late VTE with vedolizumab, these differences did not hold significance upon multivariate analysis.
  • Of particular note, urgent colectomy emerged as a notable risk factor for early complications, hospital readmission, and the necessity for redo surgery, underscoring the critical importance of timely intervention in the management of UC.
  • Additionally, patients receiving high steroid doses were found to be at increased risk of early complications, surgical site issues, and the need for repeat surgery.
  • On a positive note, the study highlighted the benefits of laparoscopic surgery, which was associated with a reduced risk of early complications, infections, and late hospital readmissions.
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These findings underscore the potential advantages of minimally invasive approaches in improving postoperative outcomes for UC patients undergoing colectomy. Overall, the study’s findings represent a significant step forward in elucidating the postoperative risks of different treatment modalities in UC management. With further research and validation, these insights have the potential to inform personalized treatment approaches tailored to the individual needs of UC patients, ultimately enhancing their quality of life and long-term outcomes.

Further reading: Dragoni G, Innocenti T, Amiot A, et al. Rates of Adverse Events in Patients With Ulcerative Colitis Undergoing Colectomy During Treatment With Tofacitinib vs Biologics: A Multicenter Observational Study. Am J Gastroenterol. Published online March 19, 2024. doi:10.14309/ajg.0000000000002676

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