Abstract

Background

Inflammatory bowel disease is a chronic, relapsing, and remitting inflammatory disorder that despite advances in medical therapy often requires hospitalization for treatment of acute flares with intravenous corticosteroids. Many patients will not respond to corticosteroids and require infliximab or cyclosporine as rescue therapy. If medical therapy fails, definitive surgical management is required. Recently, Janus Kinase inhibitors, including upadacitinib, have been proposed as an alternative rescue therapy.

Aims

We hypothesized that upadacitinib may be effective in treating acute severe colitis.

Methods

A retrospective review of 12 inflammatory bowel disease patients admitted for acute severe colitis who received upadacitinib induction therapy was performed. The rates of surgery, repeat or prolonged steroid use, and re-admission within 90 days of index hospitalization were measured. The need for re-induction with upadacitinib, change in medical therapy, rates of clinical remission, change in 6-point partial Mayo score, and laboratory markers of inflammation were measured as secondary outcomes.

Results

Five patients met the primary composite endpoint including four patients requiring surgery and one additional patient being unable to withdraw steroids within 90 days of hospital discharge. One patient required re-induction with upadacitinib within 90 days and no patients required change in medical therapy within 90 days. Most patients who did not undergo surgery were in clinical remission within 90 days and showed clinical improvement with decreased 6-point partial Mayo scores.

Conclusion

Upadacitinib may be effective salvage therapy for acute severe colitis, but larger controlled trials are required to validate these results.

中文翻译：

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乌帕替尼作为​​紧急护理环境中急性重症结肠炎的救援疗法

摘要

背景

炎症性肠病是一种慢性、复发性和缓解性炎症性疾病，尽管药物治疗取得了进步，但通常需要住院治疗，用静脉注射皮质类固醇治疗急性发作。许多患者对皮质类固醇没有反应，需要英夫利昔单抗或环孢素作为挽救治疗。如果药物治疗失败，则需要明确的手术治疗。最近，Janus 激酶抑制剂（包括 upadacitinib）被提议作为替代救援疗法。

目标

我们假设乌帕替尼可能有效治疗急性重症结肠炎。

方法

对 12 名因急性严重结肠炎入院并接受乌帕替尼诱导治疗的炎症性肠病患者进行了回顾性研究。测量了手术率、重复或长期使用类固醇以及住院后 90 天内再次入院的比率。需要用 upadacitinib 重新诱导、药物治疗的改变、临床缓解率、6 分部分 Mayo 评分的变化以及炎症的实验室标志物作为次要结果进行测量。

结果

5 名患者达到了主要复合终点，其中 4 名患者需要手术，另外一名患者在出院 90 天内无法撤回类固醇。一名患者需要在 90 天内重新接受 upadacitinib 诱导，没有患者需要在 90 天内改变药物治疗。大多数未接受手术的患者在 90 天内达到临床缓解，并显示临床改善，部分 Mayo 评分下降 6 分。

结论

乌帕替尼可能是急性重症结肠炎的有效挽救疗法，但需要更大规模的对照试验来验证这些结果。