Updated review of Janus kinase inhibitors for the management of inflammatory bowel disease - PubMed
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- #Inflammatory Bowel Disease
- #Ulcerative Colitis
- #Janus Kinase Inhibitors
- Janus kinase inhibitors (JAKi) are oral small molecules used to manage inflammatory bowel disease (IBD) by modulating cytokine-driven inflammation.
- Tofacitinib is effective for moderate-to-severe ulcerative colitis (UC) but not for Crohn's disease (CD).
- Upadacitinib shows high efficacy in both UC and CD, with emerging real-world data supporting its use in refractory cases.
- Filgotinib is effective in UC, with promising but limited data in CD.
- Safety concerns include infectious complications, cytopenias, dyslipidemia, thromboembolic risk, and impacts on pregnancy and lactation.
- Combination regimens with other biologics require caution due to additive immunosuppression.
- Long-term safety data specific to IBD are limited, with reliance on rheumatologic cohorts for extrapolation.
- JAKi, particularly tofacitinib and upadacitinib, offer alternatives for biologic-experienced and refractory IBD patients.
- Careful patient selection, screening, and monitoring are essential to mitigate risks.
- Future studies should focus on optimal sequencing, long-term safety, and gut-selective strategies.