Treatment of Chronic Inflammatory Pouch Conditions with Tofacitinib: A Case Series from 2 Tertiary IBD Centers in the United States

Approximately 10% to 15% of patients with ulcerative colitis (UC) undergo restorative proctocolectomy with ileal pouch anal anastomosis (IPAA) due to medically refractory colitis or neoplasia.1 While IPAA is an excellent alternative to a permanent end ileostomy for patients with UC, up to 50% of patients develop acute pouchitis, and 10% to 15% of patients develop chronic pouch inflammation.1 Tofacitinib, a Janus kinase 1/3 inhibitor, has been approved for induction and maintenance of remission in patients with moderate to severe UC who failed anti-Tumor necrosis factor agents.2 To date, 2 case reports showed that tofacitinib was effective for chronic pouchitis (CP)3 or Crohn s disease like pouch inflammation (CDLPI).4 On the other hand, a recent case series including 6 patients with CP, cuffitis, or CDLPI showed that 1 patient achieved clinical response, but all patients ultimately discontinued tofacitinib due to the lack of efficacy and adverse events.5 Therefore, data regarding its effectiveness are still controversial. This study aims to assess the effectiveness and safety of tofacitinib for patients with CP or CDLPI.