Banerjee Rupa, Sharma Vishal, Patel Rajendra, Jena Anuraag, Pal Partha, Raghunathan Nalini, Kumar Ajay, Sood Ajit, Puri Amarender S, Goswami Bhabhadev, Desai Devendra, Mekala Dhanush, Ramesh G N, Rao G V, Peddi Kiran, Philip Mathew, Tandon Manu, Bhatia Shobna, Godbole Shubhankar, Bhatia Sumit, Ghoshal Uday C, Dutta Usha, Midha Vandana, Prasad V G Mohan, Reddy D Nageshwar
Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Mindspace Road, Gachibowli, Hyderabad, 500 032, India.
Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160 012, India.
Indian J Gastroenterol. 2024 Feb;43(1):22-35. doi: 10.1007/s12664-023-01507-9. Epub 2024 Feb 12.
Rising number of inflammatory bowel disease (IBD) cases in developing countries necessitate clear guidance for clinicians for the appropriate use of advanced therapies. An expert consensus document was generated to guide the usage of tofacitinib, a Janus kinase inhibitor, in ulcerative colitis. Tofacitinib is a useful agent for the induction and maintenance of remission in ulcerative colitis. It can be used in the setting of biological failure or even steroid-dependent and thiopurine refractory disease. Typically, the induction dose is 10 mg BD orally. Usually, clinical response is evident within eight weeks of therapy. In those with clinical response, the dose can be reduced from 10 mg BD to 5 mg BD. Tofacitinib should be avoided or used cautiously in the elderly, patients with cardiovascular co-morbidity, uncontrolled cardiac risk factors, previous thrombotic episodes and those at high risk for venous thrombosis or previous malignancy. Baseline evaluation should include testing for and management of hepatitis B infection and latent tuberculosis. Where feasible, it is prudent to ensure complete adult vaccination, including Herpes zoster, before starting tofacitinib. The use of tofacitinib may be associated with an increased risk of infections such as herpes zoster and tuberculosis reactivation. Maternal exposure to tofacitinib should be avoided during pre-conception, pregnancy, and lactation. There is emerging evidence of tofacitinib in acute severe colitis, although the exact positioning (first-line with steroids or second-line) is uncertain.
发展中国家炎症性肠病（IBD）病例数不断增加，这就需要为临床医生提供有关合理使用先进疗法的明确指导。为此制定了一份专家共识文件，以指导溃疡性结肠炎中Janus激酶抑制剂托法替布的使用。托法替布是诱导和维持溃疡性结肠炎缓解的有效药物。它可用于生物制剂治疗失败的情况，甚至可用于激素依赖和硫嘌呤难治性疾病。通常，诱导剂量为口服10mg，每日两次。通常，治疗八周内临床反应明显。有临床反应者，剂量可从10mg，每日两次减至5mg，每日两次。老年人、患有心血管合并症的患者、未控制的心脏危险因素患者、既往有血栓形成发作的患者以及静脉血栓形成高危或既往有恶性肿瘤的患者应避免使用或谨慎使用托法替布。基线评估应包括检测和管理乙型肝炎感染及潜伏性结核。在可行的情况下，在开始使用托法替布之前，谨慎做法是确保完成包括带状疱疹疫苗在内的成人全程疫苗接种。使用托法替布可能会增加感染风险，如带状疱疹和结核再激活。在受孕前、怀孕期间和哺乳期应避免孕妇接触托法替布。有新证据表明托法替布可用于急性重症结肠炎，但其确切定位（与激素联用作为一线治疗还是二线治疗）尚不确定。
