Optimal use and cycling strategies of Janus kinase inhibitors in ulcerative colitis: current evidence and clinical implications from the KASID Guidelines Task Force Team
Year: 2026
Type: article
Abstract: Janus kinase (JAK) inhibitors are an important treatment option for ulcerative colitis, providing rapid onset of action, oral administration, and efficacy even after biologic failure. The 3 approved agents-tofacitinib, filgotinib, and upadacitinib-differ in JAK isoform selectivity, leading to clinically meaningful differences in efficacy and safety. Evidence from network meta-analyses, clinical trials, and real-world studies consistently shows that upadacitinib provides the highest efficacy for induction and maintenance of remission, whereas filgotinib demonstrates the most favorable safety profile. The strong efficacy of upadacitinib and tofacitinib is particularly relevant in patients with severe disease, including acute severe ulcerative colitis, and upadacitinib maintains high efficacy regardless of prior advanced therapy exposure. JAK inhibitors also benefit extraintestinal manifestations. Although risks such as herpes zoster, serious infection, thromboembolism, and major cardiovascular events differ among agents, long-term data suggest generally acceptable safety when used appropriately. Intraclass JAK-to-JAK cycling is feasible, with about half of patients achieving steroid-free clinical remission in retrospective cohorts. Based on mechanistic, clinical, and real-world evidence, filgotinib may be a first-line option for patients with lower disease activity or when safety is a priority, whereas upadacitinib or tofacitinib may be preferred in higher disease activity. Strategically selecting agents may improve durability and outcomes.
Source: Intestinal Research
Institutions: Pusan National University Hospital, Pusan National University, Chonnam National University, Chonnam National University Hospital, Daegu Catholic University, Daegu Catholic University Medical Center, Chung-Ang University Hospital, Chung-Ang University Healthcare System, Chung-Ang University, Ewha Womans University, Ewha Womans University Medical Center, Ewha Womans University Seoul Hospital, Samsung Medical Center, Sungkyunkwan University, Hallym University, Kangdong Sacred Heart Hospital, The Catholic University of Korea Daejeon St. Mary's Hospital, Catholic University of Korea, Kyungpook National University, Chosun University, The Catholic University of Korea Incheon St. Mary's Hospital, Yonsei University, Asan Medical Center, University of Ulsan, Yonsei University Health System, National Evidenc- based healthcare Collaborating Agency, Kosin University
Language: English
Topic: Inflammatory Bowel Disease
Subfield: Genetics
Domain: Life Sciences
Open Access status: diamond
OpenAlex ID: W7125944771