Loeb Lauren, Farraye Francis A, Crosby Sheena, Loftus Edward V, Ha Christina, Kinnucan Jami A, Picco Michael F, Hashash Jana G
Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA.
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Dig Dis Sci. 2025 Jun 14. doi: 10.1007/s10620-025-09125-5.
Recent studies have established a role for Janus kinase (JAK) inhibitors in the management of patients with inflammatory bowel disease. However, these studies excluded patients with an ileostomy.
We sought to evaluate the clinical response of patients with Crohn's disease (CD) and ileostomy who were treated with upadacitinib.
This retrospective study included patients with CD who had an ileostomy secondary to medically refractory CD and who were treated with upadacitinib. Patients who underwent ileostomy takedown and continued taking upadacitinib were analyzed separately from patients with an ileostomy throughout upadacitinib treatment duration. The primary endpoint was clinical response defined by either continuation or discontinuation of upadacitinib. The secondary endpoint was identifying variables that lead to discontinuation of upadacitinib.
A total of 48 patients, between the ages of 17-70 years met our inclusion criteria of having CD, an ileostomy, and upadacitinib use after ileostomy creation. Of the 48 patients, 32 (67%) had clinical improvement in CD activity with upadacitinib use based on review of clinical documentation. Upadacitinib was discontinued in 16 patients (33%) for various reasons including refractory symptoms related to CD, deep vein thrombosis, anemia/leukopenia, insurance denial, pregnancy planning, headache/back pain, or squamous cell carcinoma of the skin.
We evaluated the efficacy of upadacitinib in patients with CD and ileostomy. Two-thirds of our cohort experienced improvement in CD-related symptoms with upadacitinib use. Further studies are needed to evaluate if altered gastrointestinal anatomy significantly impacts absorption and efficacy of upadacitinib in patients with CD.
最近的研究确立了Janus激酶（JAK）抑制剂在炎症性肠病患者管理中的作用。然而，这些研究排除了有回肠造口术的患者。
我们试图评估接受乌帕替尼治疗的克罗恩病（CD）和回肠造口术患者的临床反应。
这项回顾性研究纳入了因药物难治性CD而接受回肠造口术且接受乌帕替尼治疗的CD患者。在整个乌帕替尼治疗期间，对接受回肠造口术拆除并继续服用乌帕替尼的患者与有回肠造口术的患者进行了单独分析。主要终点是由乌帕替尼的继续使用或停用所定义的临床反应。次要终点是确定导致停用乌帕替尼的变量。
共有48名年龄在17至70岁之间的患者符合我们的纳入标准，即患有CD、有回肠造口术且在回肠造口术后使用乌帕替尼。根据临床记录回顾，在这48名患者中，32名（67%）在使用乌帕替尼后CD活动有临床改善。16名患者（33%）因各种原因停用了乌帕替尼，这些原因包括与CD相关的难治性症状、深静脉血栓形成、贫血/白细胞减少、保险拒付、妊娠计划、头痛/背痛或皮肤鳞状细胞癌。
我们评估了乌帕替尼在CD和回肠造口术患者中的疗效。我们队列中的三分之二患者在使用乌帕替尼后CD相关症状有所改善。需要进一步研究以评估胃肠道解剖结构的改变是否会显著影响乌帕替尼在CD患者中的吸收和疗效。
