The following is a summary of “Tofacitinib Salvage Therapy for Children Hospitalized for Corticosteroid- and Biologic-Refractory Ulcerative Colitis” published in the December 2022 issue of Pediatric Gastroenterology and Nutrition by Constant et al.

Despite intravenous corticosteroids and intensified anti-tumor necrosis factor (TNF) biologic dosing, the rate of colectomy following acute, severe ulcerative colitis has plateaued around 20%. Tofacitinib has been found in recent studies to be beneficial in reducing the rate of colectomy in adult patients hospitalized with ulcerative colitis who have not responded to corticosteroids or anti-TNF therapy. However, there is currently a lack of data documenting the efficacy of tofacitinib in children and adolescents for this purpose. The study aimed to document the course of treatment and colectomy-free survival rates for children hospitalized with refractory ulcerative colitis who were given tofacitinib. The children with refractory ulcerative colitis who were hospitalized and started on tofacitinib between 2018 and 2021 were the subjects of a retrospective single-center cohort study. Overall survival without further colectomy at 90 days was the primary endpoint.

Clinical remission without colectomy, independence from corticosteroids, persistence on tofacitinib medication without colectomy, adverse events, and complications following surgery were secondary outcomes. Patients’ pre-hospital characteristics and the date and location of their treatments in the hospital were detailed. Counts, percentages, and Kaplan-Meier curves were used to illustrate the results. About 11 people were eligible for the study. Patients who did not respond to intravenous corticosteroids and anti-TNF therapy were then given tofacitinib. The average maximal activity index for pediatric ulcerative colitis while hospitalized was 68, and the median length of stay was 22 days.

At 90 days after hospital admission, 8 of 11 patients had not undergone a colectomy, and 6 patients, including 4 still on tofacitinib, had not undergone a colectomy at the median 182-day follow-up. For children with ulcerative colitis who have not responded to corticosteroids or anti-TNF treatment, tofacitinib shows promise as a novel therapeutic option for use in the hospital setting. More study is needed to pinpoint where exactly these treatments should go.