Background: Up to 30% of patients with acute severe ulcerative colitis (ASUC) will require urgent colectomy despite initiation of IV corticosteroids and rescue therapies. Janus kinase inhibitors, such as tofacitinib, have emerged as an effective agent for ASUC; however, there is currently limited data evaluating the risk of postoperative complications among patients who received tofacitinib treatment for an episode of ASUC compared to infliximab.

Methods: We conducted a multicenter, retrospective, case-control study of patients hospitalized with ASUC who underwent colectomy, comparing patients tofacitinib-treated patients to infliximab-treated patients prior to colectomy. The primary outcome was rate of serious postoperative complications within 30 days of colectomy. Outcomes were compared between the tofacitinib-treated cases and infliximab-treated controls using multivariable regression adjusted for open surgery and cumulative corticosteroid exposure.

Results: Forty-one tofacitinib-treated patients were compared to 68 infliximab-treated patients with ASUC. Compared to tofacitinib-treated patients, infliximab-treated patients had higher overall rates of overall (44 [64.7%] vs 13 [31.7%], p = 0.002) and serious (19 [27.9%] vs 3 [12%], p= 0.019) postoperative complications. No significant different risk for developing serious postoperative complications (OR 0.28 [95% CI 0.06, 0.96]; p = 0.061) was observed in multivariable analysis; however, a significantly lower rate of overall postoperative complications (OR 0.38 [95% CI 0.16, 0.87]; p =0.023) was observed in tofacitinib-treated patients compared to infliximab-treated patients.

Conclusions: We observed a significantly lower rate of overall postoperative complications in ASUC patients treated with tofacitinib compared to infliximab; however, no difference was observed in the risk for serious postoperative complications. Larger prospective trials are needed to confirm these findings.