Role of JAK Inhibitors in Steroid-dependent IBD

Abstract

Background: Long-term corticosteroid-related complications result in steroid dependence in inflammatory bowel disease (IBD), which continues to be a significant challenge in its treatment. JAK inhibitors have also become a useful oral targeted agent in moderate-to-severe IBD providing quick onset of activity and may have steroid-sparing effects. Objective: To evaluate the efficacy and safety of JAK inhibitors in achieving steroid-free remission among patients with steroid-dependent IBD. Methods: This is a prospective observational cohort study that was carried out at Faisalabad Teaching Hospital, Faisalabad Medical University, between March 2024 and August 2024. A total of 86 adult patients with steroid-dependent ulcerative colitis or Crohn disease were included. Patients received standard-dose tofacitinib or upadacitinib and were followed at 8 and 24 weeks. The primary outcome was steroid-free clinical remission at 24 weeks. Mainly, steroid-free clinical remission was attained at 24 weeks. The secondary outcomes were clinical response, inflammatory markers reduction, steroid discontinuation rate, and safety profile. The SPSS version 26 was used to analyze the data, and p ≤ 0.05 was considered significant. Results: At 24 weeks, JAK inhibitor therapy was associated with significant improvement in clinical and laboratory outcomes. Steroid-free remission and complete steroid discontinuation were achieved in a substantial proportion of patients, with parallel reductions in CRP and fecal calprotectin levels. Adverse events were mostly mild and manageable, and treatment discontinuation due to adverse events was uncommon. Conclusion: Tofacitinib and upadacitinib appear to be effective and reasonably safe steroid-sparing options in patients with steroid-dependent IBD. They demonstrated favorable remission outcomes with acceptable tolerability over 24 weeks.