BackgroundThree Janus kinase (JAK) inhibitors are approved for ulcerative colitis (UC) in Japan.AimTo compare the real‐world efficacy and safety of these three JAK inhibitors in UC.MethodsThis was a multicentre, retrospective study of patients with UC started on JAK inhibitors. The primary outcome was clinical remission at 10, 26 and 58 weeks, and at the most recent follow‐up. To compare the efficacy and safety among the JAK inhibitors, we created three matched cohorts (upadacitinib vs. filgotinib, tofacitinib vs. filgotinib and upadacitinib vs. tofacitinib) using propensity score matching.ResultsWe identified 228 upadacitinib‐treated patients (median follow‐up 49 weeks; IQR 25–72), 215 filgotinib‐treated patients (follow‐up 56 weeks; IQR 17–82) and 159 tofacitinib‐treated patients (follow‐up 112 weeks; IQR 10–258). Clinical remission rates for upadacitinib, filgotinib and tofacitinib at the most recent follow‐up were 72.8%, 50.6% and 45.8%, respectively. Over 70% of the patients previously treated with other biologics or JAK inhibitors achieved clinical remission with upadacitinib. On multivariate analysis, the number of previous advanced therapies was inversely associated with the efficacy of filgotinib and tofacitinib. Comparative analysis showed that upadacitinib‐treated patients had higher efficacy and lower risk of discontinuation than patients treated with other JAK inhibitors. However, upadacitinib had a significant risk of acne.ConclusionsConsidering the particularly high efficacy of upadacitinib, even in patients with refractory UC, filgotinib or tofacitinib may be considered as an upfront JAK inhibitor before using upadacitinib.

中文翻译：

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三种 Janus 激酶抑制剂在溃疡性结肠炎中的疗效和安全性比较：日本的一项真实世界多中心研究


背景三种 Janus 激酶 （JAK） 抑制剂在日本被批准用于溃疡性结肠炎 （UC）。目的比较这三种 JAK 抑制剂在 UC 中的真实疗效和安全性。方法这是一项针对开始使用 JAK 抑制剂的 UC 患者的多中心回顾性研究。主要结局是 10 、 26 和 58 周以及最近一次随访时的临床缓解。为了比较 JAK 抑制剂之间的疗效和安全性，我们使用倾向评分匹配创建了三个匹配的队列 （upadacitinib vs. filgotinib、tofacitinib vs. filgotinib 和 upadacitinib vs. tofacitinib）。结果我们确定了 228 例 upadacitinib 治疗的患者 （中位随访 49 周;IQR 25-72），215 名 filgotinib 治疗的患者（随访 56 周;IQR 17-82）和 159 名托法替布治疗的患者（随访 112 周;IQR 10-258）。在最近的随访中，upadacitinib 、 filgotinib 和 tofacitinib 的临床缓解率分别为 72.8% 、 50.6% 和 45.8%。超过 70% 的既往接受过其他生物制剂或 JAK 抑制剂治疗的患者在接受 upadacitinib 治疗后达到临床缓解。在多变量分析中，既往先进疗法的数量与 filgotinib 和 tofacitinib 的疗效呈负相关。比较分析显示，upadacitinib 治疗的患者比接受其他 JAK 抑制剂治疗的患者疗效更高，停药风险更低。然而，upadacitinib 有显着的痤疮风险。结论考虑到 upadacitinib 的特别高疗效，即使在难治性 UC 患者中，也可考虑在使用 upadacitinib 之前将 filgotinib 或 tofacitinib 作为前期 JAK 抑制剂。