P0612 Postoperative outcomes in tofacitinib-treated patients with acute severe ulcerative colitis undergoing total abdominal colectomy
Authors: Larson C , Berinstein J A , Tedesco N , Seidelin J B , Ovesen P D , Uzzan M , Amiot A , Nuzzo A , Laharie D , Constant B D , Albenberg L , El-Hussuna A , Bishu S , Cohen-Mekelburg S , Higgins P D R , Steenholdt C 
Published: January 2025

Abstract

Background
Up to 30% of patients with acute severe ulcerative colitis (ASUC) require urgent colectomy despite IV corticosteroids and rescue therapies with infliximab or cyclosporin. JAK-inhibitors, like tofacitinib, have emerged as effective treatments for ASUC, but data on postoperative complications are limited.1, 2

Methods
We conducted a multicenter, retrospective, case-control (1:2) study of patients hospitalized with ASUC who underwent colectomy, comparing patients treated with tofacitinib (cases) prior to their colectomy with those treated with usual care (controls).1 The primary outcome was rate of serious postoperative complications within 30 days of colectomy defined as Clavien-Demartines-Dindo classification grade ≥3. Outcomes were compared between the tofacitinib-treated cases and controls using adjusted multivariable regression analysis.

Results
In all, 41 tofacitinib-treated ASUC patients were compared to 83 patients with ASUC who received usual stand of care. Among patients treated with usual care, 68 (82%) patients received rescue infliximab, 1 (1%) had rescue cyclosporine, and 80 (96%) had corticosteroids within 24 hours of colectomy compared to patients in the tofacitinib-treated group, where 5 (12%) had rescue infliximab, 4 (10%) rescue cyclosporine, and 34 (83%) corticosteroids. Compared to tofacitinib-treated patients, patients who received usual care had higher rates of serious postoperative complications (24 [29%] vs 5 [12%], p=0.023) and overall postoperative complications (51 [61.4%] vs 13 [31.7%], p=0.003). Multivariable regression adjusted for CRP, albumin, age at the time of colectomy, open surgery, preoperative length of stay, ASA classification, as well as concomitant corticosteroid and infliximab use did, however, not demonstrate a significantly different risk for developing both serious postoperative complications (OR 0.52 [95% CI 0.07-3.11], p=0.5) or overall postoperative complications (OR 1.00 [0.28-3.55], p&gt;0.9) between the tofacitinib-treated group and usual care group. Overall rates of 30-day VTE were also similar in the two groups (tofacitinib group: 2 [4.9%] vs usual-care group: 5 [6.0%], p=0.16), but numerically higher for delayed VTE within 31-90 days in the usual-care group (2 [2.4%] vs 0 [0%], p=0.81). One patient (2%) treated with tofacitinib died from septic shock secondary to infectious pneumonia 14 days after surgery, whereas no deaths occurred in the usual care group (p=0.72). Postoperative length of stay was similar between groups (5 [4-8] vs 7 [4-11], p=0.14).

Conclusion
No difference in postoperative complications was observed between tofacitinib-treated and usual care ASUC patients. Larger prospective trials are needed to confirm these findings.

References
1.Steenholdt C, Dige Ovesen P, Brynskov J, et al. Tofacitinib for Acute Severe Ulcerative Colitis: A Systematic Review. J Crohns Colitis 2023;17:1354-1363.
2.Singh A, Goyal MK, Midha V, et al. Tofacitinib in Acute Severe Ulcerative Colitis (TACOS): A Randomized Controlled Trial. Am J Gastroenterol 2024;119:1365-1372.