Tofacitinib acts by preferentially inhibiting JAK1 and JAK3, with reduced inhibition for JAK2 and tyrosine kinase 2. This, in turn, inhibits the signal transduction activity by the surface receptors for multiple cytokines including an important subset of pro-inflammatory cytokines such as interleukin (IL)-2, -4, -7, -9, -15, and -21 and interferon gamma (IFN-y) cytokines, which are integral to lymphocyte activation, proliferation, and function.12,13 Tofacitinib offers a nonselective anti-inflammatory treatment that, in this case, successfully maintained the patient's colitis while also controlling her arthritis. Tofacitinib is orally taken, has a short pharmacokinetic half-life of 3.2 hours, and is rapidly absorbed and eliminated, with reversibility of pharmacodynamic effects within 14 days of discontinuation.14,15 Tofacitinib is now recommended as an option for first-line therapy in patients suffering from moderately to severely active UC and would be an appropriate first-line option in similar cases.16 We believe that this is the first reported case of a patient treated with concomitant use of tofacitinib and vedolizumab and the first patient with UC to receive the extended-release formulation of tofacitinib in the maintenance phase. This case provides insight into the future management options in UC and such EIMs.
Author contributions: W. Wang, NK Clevland, and J. Ollech wrote the manuscript. DT Rubin reviewed and approved the final version of the manuscript and is the article guarantor.
Financial disclosure: DT Rubin is a consultant and has received grant support from AbbVie, Janssen, Pfizer, Takeda.
Previous presentation: This case report was presented at the 2017 ACG Annual Meeting; October 13–15, 2017; Orlando, Florida.
Informed consent was obtained for this case report.
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