Vespere Giuliana, Sedda Silvia, Madonna Pasquale, Abete Roberta, D'Avino Alfredo, Maione Manuela, Lugarà Marina, Tazza Antonietta, Scaldaferri Franco, Vitiello Giuseppe, De Luca Leonardo
Department of Gastroenterology and Endoscopy, Ospedale del Mare, Naples, Italy.
Department of Medicine, Ospedale del Mare, Naples, Italy.
Case Rep Gastroenterol. 2025 Apr 25;19(1):289-297. doi: 10.1159/000545263. eCollection 2025 Jan-Dec.
Acute severe ulcerative colitis (ASUC) is a serious complication affecting 9%-15% of patients with UC within 3 months of diagnosis and up to 28% of patients during the course of the disease. Despite the use of infliximab and calcineurin inhibitors, the rate of colectomy remains high both during the hospitalization and in the 5 years after an acute episode. We present a case of ASUC that was unresponsive to conventional therapies but was successfully treated with filgotinib.
A 21-year-old male with a recent diagnosis of UC presented to our hospital with a severe flare. He received rescue therapy of high-dose intravenous steroids and 10 mg/kg infliximab. We observed little clinical and biochemical benefits. The patient declined the surgical option. Therefore, we decided to start a second rescue therapy with a new and rapid-acting Janus kinase inhibitor, filgotinib, due to its characteristics and pharmacokinetic profile of rapid absorption and metabolism. The patient showed an immediate clinical and biochemical response at 48 h, an endoscopic response at week 3, and an endoscopic remission at week 10. No recurrence was observed after 12 months of follow-up. The patient is in clinical remission with a good quality of life.
Filgotinib may be an effective second-line therapy in an emergency setting such as ASUC in patients unresponsive to conventional therapy.
急性重症溃疡性结肠炎（ASUC）是一种严重并发症，在溃疡性结肠炎（UC）患者确诊后的3个月内，有9% - 15%的患者会受到影响，在疾病过程中这一比例高达28%。尽管使用了英夫利昔单抗和钙调神经磷酸酶抑制剂，但在住院期间以及急性发作后的5年里，结肠切除术的比例仍然很高。我们报告一例对传统疗法无反应但用非戈替尼成功治疗的ASUC病例。
一名最近诊断为UC的21岁男性因严重病情发作前来我院就诊。他接受了大剂量静脉注射类固醇和10mg/kg英夫利昔单抗的抢救治疗。我们观察到临床和生化方面几乎没有改善。患者拒绝手术治疗。因此，鉴于新型速效Janus激酶抑制剂非戈替尼具有快速吸收和代谢的特点及药代动力学特征，我们决定开始用其进行第二次抢救治疗。患者在48小时时出现了即时的临床和生化反应，第3周时出现内镜反应，第10周时达到内镜缓解。随访12个月后未观察到复发。患者处于临床缓解状态，生活质量良好。
对于对传统治疗无反应的患者，在ASUC等紧急情况下，非戈替尼可能是一种有效的二线治疗药物。
