Combination Tofacitinib and Calcineurin Inhibitor in the Management of Treatment-Refractory Ulcerative Colitis May Be Effective, But Is It Necessary?

Abstract

To the Editors: We read with interest the report from Yang et al1 on the use of combination tofacitinib and cyclosporin for the management of treatment refractory ulcerative colitis (UC) in a patient with primary nonresponse to infliximab. It must be acknowledged that sequential use of calcineurin inhibition and anti-tumor necrosis factor salvage therapy has been associated with high rates of adverse and serious adverse events, and there are currently insufficient data to guide treatment recommendations. Emerging evidence within small inflammatory bowel disease cohorts suggests that use of combination immunosuppressants, with tofacitinib in particular, may be a safe and effective strategy for the treatment of refractory patients.2 Adequately powered prospective trials with sufficient follow-up are required to confirm these preliminary findings. At present, the combined use of tofacitinib and ciclosporin is listed as a contraindication in the product information for tofacitinib. The basis for this recommendation is unclear;...