Work

Risk factors of short-term colectomy following Janus kinase inhibitor therapy in acute severe ulcerative colitis: a systematic review and meta-analysis of individual-level data from real-world studies

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Background Emerging evidence supports the use of Janus kinase inhibitors (JAKi) in acute severe ulcerative colitis (ASUC). However, risk factors associated with non-response and the need for short-term colectomy in ASUC patients treated with JAKi remain poorly understood. Methods We conducted a systematic review and individual-level data meta-analysis of real-world studies evaluating tofacitinib or upadacitinib for the treatment of ASUC. The primary and secondary outcomes were colectomy within 30 days and 12 weeks, respectively. Generalized linear mixed-effects models were used for univariable and multivariable analyses to estimate odds ratios (ORs). A stratified Cox proportional hazards model was used to assess colectomy-free survival. Results Twenty-three studies with 145 patients were included (69.0% treated with tofacitinib, 31.0% with upadacitinib). The overall colectomy rate was 13.1% within 30 days and 20.5% within 12 weeks. In univariable analyses, prior exposure to anti-tumor necrosis factor (TNF) therapy before ASUC hospitalization was statistically significantly associated with lower odds of colectomy within 30 days (OR 0.44, P = .006) and 12 weeks (OR 0.51, P = .008). Prior anti-TNF exposure remained significantly associated with lower odds of colectomy in multiple multivariable analyses. No other clinical or laboratory variables were significantly associated with primary/secondary outcomes. Conclusions Prior anti-TNF exposure before hospitalization is associated with lower short-term colectomy rates in ASUC patients treated with JAKi. Our findings highlight the need for future studies to optimize the position of JAKi in the ASUC management algorithm and to identify novel predictive biomarkers to advance precision medicine strategies.

Source: Crohn s & Colitis 360

DOI: 10.1093/crocol/otag120