Raymond Cross, MD, on JAK Inhibitors in IBD

Dr Cross reviews his presentation from the AIBD regional meeting on the use, safety, and positioning of Janus kinase inhibitors for the treatment of IBD.

Raymond Cross, MD, is director of the Center for Inflammatory Bowel and Colorectal Diseases​ at Mercy Medical Center and a professor of medicine at the University of Maryland School of Medicine in Baltimore, Maryland.

Hello everyone, I'm Raymond Cross and I'm at the AIBD regional and just did a presentation on JAK inhibitors. So over this short 15-minute talk we covered a fair amount of ground about what type of therapy JAK inhibitors are, being small molecules; what JAK inhibitors do in regards to release of cytokines, important in inflammation; and then review the 2 approved jack inhibitors for IBD, tofacitinib and upadacitinib.

Importantly, looking at the pivotal clinical trials for UC for tofacitinib and for UC and Crohn's for upadacitinib. We also looked at some subsets of patients, including those with acute severe colitis, and reviewed some data from the University of Maryland and NYU on use of upadacitinib in 12 severe colitis patients and the efficacy in that subgroup of patients in ulcerative all sort of colitis, looking at resolution in rectal bleeding and improvement in stool frequency, which can occur as early as 1 or 2 days after starting treatment with upadacitinib. I also reviewed some data on real-world experience with upadacitinib in both Crohn's and ulcerative colitis in approximately 100 patients.

And then lastly, one of the major barriers to using JAK inhibitors in clinical practice is concerns of safety. We reviewed the OCTAVE clinical trial program looking at over 6 years of safety data with tofacitinib, which is overall quite reassuring, and we also reviewed the ORAL surveillance study in rheumatoid arthritis, which did show a higher rate of cardiovascular events and malignancy in tofacitinib-treated patients compared to anti-TNF treated patients. But importantly, we emphasize the patients that had no prior cardiovascular history did not have an increased risk, and likewise those that were under 65 and there were not smokers had no increased risk of cancer, and lastly, those without a prior history of thromboembolic disorders also did not have a higher risk of thromboembolic outcomes either.

So hopefully you got a chance to attend this session at the regional and I hope to see you at future regionals.