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Category: Volume 09 Issue 03 March 2021
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Title: Symptomatic Improvement and Mucosal Healing in UC Patients – A Short- Term Randomised Trial Comparing Tofacitinib with Mesalamine

Authors: Dr Swarup Chakraborty, Dr Pinaki Roy

 DOI: https://dx.doi.org/10.18535/jmscr/v9i3.03

Abstract

Background: Inflammatory bowel disease (IBD) recently, since the last few decades have found a respectable position amongst the Indian sub-continent owing to the emerging transcendence of stress and westernization of Indian food culture. Usually, it is characterized as Crohn's disease (CD) and Ulcerative colitis (UC). Spontaneous uncontrolled mucosal flare-ups hallmark as its sine- qua non feature. UC was firstly described by Sir Samuel Wilks in 1859, inflammation being restricted to the colon. CD as described and named after Dr. Burrill B. Crohn, usually includes the entire gastrointestinal tract (GIT). Ulcerative colitis (UC), a chronic inflammatory disorder still idiopathic, presents typically with symptoms such as blood mixed diarrhea, pain abdomen and rectal urgency. UC is a complementary, clinical cum colonoscopy diagnosis. Remission induction and maintenance of the remission are its primary goals. For mild-to-moderate disease, oral or rectal formulations of 5-aminosalicylic acid are usually used. In moderate-to-severe flare- ups of UC, corticosteroids are usually used, with or without another class of medications such as thiopurines or biologics including anti-tumor necrosis factor, anti-integrins.

Janus kinase inhibitors (Tofacitinib) is a new class of drug used for remission induction that has been very recently FDA approved in 2018.

Methods: This study is a short-term approach to consider the symptomatic score improvement and colonoscopy healing comparing the time tested Mesalamine with its newer contender Tofacitinib in the form of a randomized controlled trial amongst 100 patients of mild to moderate UC, over a period of 06 months.

Results: Both groups had statistically comparable results, though Tofacitinib showed faster signs of colonoscopy healing but showed up with slightly more side effects when compared with Mesalamine.

Conclusion: The current study is an eye-opener so as to, not quickly jump to newer drugs but consider the correct timing of a newer drug introduction for better long-term remission of a crippling disease like UC that requires life style modifications as an essential criterion in addition to medicines for symptom-free remission and maintenance.

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Corresponding Author

Dr Swarup Chakraborty

Associate Professor, Surgery, Calcutta National Medical College, Kolkata- 14