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USING A JAK-STAT INHIBITOR IN MODERATE-SEVERE ULCERATIVE COLITIS ASSOCIATED WITH HIDRADENITIS SUPPURATIVA: PROBABLY NOT A FAUX PAS!

Raffaele Pellegrino 1, Giovanna Palladino 1, Mariachiara Di Nuzzo 1, Rossella D’Onofrio 1, Giusi Arboretto 1, Giuseppe Imperio 1, Salvatore Auletta 1, Andrea Carmelo Ventura 1, Marina Cipullo 1, Alessandro Federico 1, Antonietta Gerarda Gravina 1

Affiliations

1 University of Campania "Luigi Vanvitelli", Naples, Italy

Summary

AI Generated

A case report describes marked improvement of both ulcerative colitis and concurrent hidradenitis suppurativa in a 26-year-old woman treated with tofacitinib after adalimumab failure.

The patient had pancolitis (UC E3, Mayo ESS 2) with steroid dependence and primary failure to adalimumab, plus hidradenitis suppurativa affecting axillary folds, inguinal folds, and intermammary groove that failed topical dermatologic treatment.
Tofacitinib 20 mg daily was introduced in March 2022 for 16 weeks (extended induction), achieving UC clinical and biochemical remission and marked amelioration of hidradenitis suppurativa.
The patient continues maintenance therapy with tofacitinib 10 mg daily.
The authors note there is no prior evidence on the efficacy of tofacitinib in hidradenitis suppurativa, though it has been introduced into European guidelines for moderate-severe ulcerative colitis.
This case may interest gastroenterologists and dermatologists managing patients with concurrent inflammatory bowel disease and hidradenitis suppurativa.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Clinical Case Summary

Tofacitinib has recently been introduced into European guidelines for managing moderate-severe Ulcerative Colitis (UC). Among the various extra-intestinal manifestations of UC is Hidradenitis Suppurativa (HS), also called acne inversa. Unfortunately, there is no evidence on the efficacy of tofacitinib in HS, such that recommendations generally suggest anti-tumour necrosis factors, antibiotics, anakinra, ustekinumab or surgery. We report the case of a 26-year-old Caucasian non-smoking, nonalcohol-drinking, and non-obese woman diagnosed with UC E3 (i.e., pancolitis) according to Montreal classification with Mayo endoscopic subscore (ESS) of 2 at the age of 23 years old. At the time, the patient underwent conventional therapy with oral prednisone at the immunosuppressive dosage combined with oral mesalazine. Following this therapy, she achieved clinical-biochemical remission. A year later, she developed a UC relapse associated with steroid dependence, also received another colonoscopy (E3, ESS=2, C-Reactive protein 18.6 mg/L) and received a dermatologic diagnosis of HS (mainly localized to axillary folds, inguinal folds, intermammary groove) and treated employing topical triamcinolone/neomycin cream. In addition, we introduced Adalimumab. She then experienced primary failure. Due to the persistence of moderate-severe symptoms and iron-deficiency anaemia, we introduced tofacitinib therapy in March 2022. At that moment, the patient had an HS relapse which the previous dermatologic treatment failed. Therefore, the patient undertook tofacitinib induction with 20 mg daily for eight weeks. Because of clinical improvement with the halving of discharges and absence of blood, however, complete clinical remission was not achieved. Therefore, it was decided to continue this regimen for another eight weeks. At the end of the 16 weeks, we noted UC clinical and biochemical remission and a marked amelioration of HS. Today, the patient continues a 10 mg daily tofacitinib regimen.

References

- Chen W-T, Chi C-C. Association of Hidradenitis Suppurativa With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. JAMA Dermatol 2019;155:1022–7.
- Goldburg SR, Strober BE, Payette MJ. Hidradenitis suppurativa: Epidemiology, clinical presentation, and pathogenesis. J Am Acad Dermatol 2020;82:1045–58.
- Savage KT, Santillan MR, Flood KS, Charrow A, Porter ML, Kimball AB. Tofacitinib shows benefit in conjunction with other therapies in recalcitrant hidradenitis suppurativa patients. JAAD Case Rep 2020;6:99–102.
- Raine T, Bonovas S, Burisch J, Kucharzik T, Adamina M, Annese V, Bachmann O, Bettenworth D, Chaparro M, Czuber-Dochan W, Eder P, Ellul P, Fidalgo C, Fiorino G, Gionchetti P, Gisbert JP, Gordon H, Hedin C, Holubar S, Iacucci M, Karmiris K, Katsanos K, Kopylov U, Lakatos PL, Lytras T, Lyutakov I, Noor N, Pellino G, Piovani D, Savarino E, Selvaggi F, Verstockt B, Spinelli A, Panis Y, Doherty G. ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment. J Crohns Colitis. 2022 Jan 28;16(1):2-17.

Conference

UEG Week Copenhagen 2023

Topics

IBD

Submission format

Clinical Case

Session

PP 12 Clinical Cases (Posters)

Published

2023

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THE EFFECT OF A PERIPHERALLY ACTING OPIOID ANTAGONIST ON ACUTE PANCREATITIS: A MULTICENTRE RANDOMISED CONTROLLED TRIAL

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THE EFFECT OF A PERIPHERALLY ACTING OPIOID ANTAGONIST ON ACUTE PANCREATITIS: A MULTICENTRE RANDOMISED CONTROLLED TRIAL

Cecilie Siggaard Knoph 1,2, Mathias Ellgaard Cook 1,2, Srdan Novovic 3,4, Mark Berner-Hansen 5, Michael Bau Mortensen 6, Liv Bjerre Juul Nielsen 5, Irene Maria Høgsberg 6, Celina Salomon 7, Sanjay Pandanaboyana 8, Lone Schmidt Soerensen 1, Ole Thorlacius-Ussing 1, Jens Brøndum Frøkjær 1, Søren Schou Olesen 1,2, Asbjørn Mohr Drewes 2,1

Affiliations

1 Aalborg University Hospital, Aalborg, Denmark

2 Aalborg University, Aalborg, Denmark

3 University of Copenhagen, Copenhagen, Denmark

4 Copenhagen University Hospital Hvidovre, Hvidovre, Denmark

5 Bispebjerg Hospital, Bispebjerg, Denmark

6 Department of Surgery, Odense University Hospital, Odense, Denmark

7 Odense University Hospital, Svendborg, Denmark

8 Freeman Hospital, Newcastle upon Tyne, United Kingdom