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Safety and Effectiveness of Janus Kinase Inhibitors in the Management of Inflammatory Bowel Disease Following Liver Transplantation.
Con, Danny; Hilley, Patrick; Chin, Simone; Corte, Crispin; Hafeez, Bilal; Testro, Adam; De Cruz, Peter; Choy, Matthew; Srinivasan, Ashish.
Afiliação
  • Con D; Department of Gastroenterology, Austin Health, Heidelberg, VIC, Australia.
  • Hilley P; Department of Medicine, Austin Academic Centre, University of Melbourne, Melbourne, VIC, Australia.
  • Chin S; Department of Gastroenterology, Austin Health, Heidelberg, VIC, Australia.
  • Corte C; Department of Medicine, Austin Academic Centre, University of Melbourne, Melbourne, VIC, Australia.
  • Hafeez B; AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
  • Testro A; AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
  • De Cruz P; Faculty of Medicine and Health, Central Clinical School, University of Sydney, NSW, Australia.
  • Choy M; Department of Medicine, Austin Academic Centre, University of Melbourne, Melbourne, VIC, Australia.
  • Srinivasan A; Department of Gastroenterology, Austin Health, Heidelberg, VIC, Australia.
J Crohns Colitis ; 18(9): 1505-1509, 2024 Sep 03.
Article em En | MEDLINE | ID: mdl-38502366
ABSTRACT

BACKGROUND:

The management of inflammatory bowel disease [IBD] patients with concurrent liver transplantation is challenging, and data regarding the safety and efficacy of Janus kinase [JAK] inhibitors with anti-rejection medications are required. We report the experience of all liver transplant recipients receiving tofacitinib and/or upadacitinib for IBD across three states in Australia.

METHODS:

All liver transplant recipients from the Australian states of Victoria, New South Wales, and Tasmania, who required tofacitinib or upadacitinib for the treatment of IBD, were identified using prospectively maintained liver transplant databases. Patients were followed up until medication cessation or last follow-up. Clinical safety and efficacy data were collected.

RESULTS:

Eight patients [median age 30 years] were included, seven of whom received first-line JAK inhibition with tofacitinib. All patients had failed one or more biologic therapies prior to commencing JAK inhibition, including six patients who had failed two or more agents. JAK inhibition was continued for a median of 17 months, with 143 patient-months of combined follow-up. The anti-rejection medication tacrolimus was prescribed in all patients. Overall, seven [88%] patients achieved clinical remission, including all three patients who were switched from tofacitinib to upadacitinib. One patient required colectomy after 1 month of treatment. There were no other cases of serious infection, venous thromboembolism, or major adverse cardiovascular events during follow-up.

CONCLUSIONS:

As the largest case series to date, these data indicate that combining JAK inhibition with transplant anti-rejection medication may be a safe and clinically effective method of treating IBD in patients with prior biologic failure.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Piperidinas / Pirimidinas / Doenças Inflamatórias Intestinais / Transplante de Fígado / Inibidores de Janus Quinases / Compostos Heterocíclicos com 3 Anéis Limite: Adult / Female / Humans / Male / Middle aged País/Região como assunto: Oceania Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Piperidinas / Pirimidinas / Doenças Inflamatórias Intestinais / Transplante de Fígado / Inibidores de Janus Quinases / Compostos Heterocíclicos com 3 Anéis Limite: Adult / Female / Humans / Male / Middle aged País/Região como assunto: Oceania Idioma: En Ano de publicação: 2024 Tipo de documento: Article