Janus 激酶抑制剂治疗肝移植后炎症性肠病的安全性和有效性。

Danny Con, Patrick Hilley, Simone Chin, Crispin Corte, Bilal Hafeez, Adam Testro, Peter De Cruz, Matthew Choy, Ashish Srinivasan
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引用次数: 0

摘要

背景:对同时接受肝移植的炎症性肠病(IBD)患者的管理具有挑战性,需要有关Janus激酶(JAK)抑制剂与抗排斥药物的安全性和有效性的数据。我们报告了澳大利亚三个州所有接受托法替尼和/或达达替尼治疗IBD的肝移植受者的经验:我们利用前瞻性维护的肝移植数据库,确定了澳大利亚维多利亚州、新南威尔士州和塔斯马尼亚州所有需要使用托法替尼或达达替尼治疗 IBD 的肝移植受者。对患者进行了随访,直至停药或最后一次随访。收集了临床安全性和疗效数据:共纳入8名患者(中位年龄为30岁),其中7名患者接受了托法替尼的一线JAK抑制治疗。所有患者在开始使用JAK抑制剂之前都曾失败过一种或多种生物疗法,其中六名患者曾失败过两种或两种以上的药物。JAK抑制剂的中位随访时间为17个月,总随访时间为143个月。所有患者都服用了抗排斥药物他克莫司。总体而言,7 名患者(88%)获得了临床缓解,其中包括从托法替尼转为奥达替尼的全部 3 名患者。一名患者在治疗 1 个月后需要进行结肠切除术。随访期间没有发生其他严重感染、静脉血栓栓塞或重大不良心血管事件:作为迄今为止最大的病例系列,这些数据表明,将JAK抑制与移植抗排斥药物结合使用可能是治疗既往生物治疗失败患者IBD的一种安全且临床有效的方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Safety and Effectiveness of Janus Kinase Inhibitors in the Management of Inflammatory Bowel Disease Following Liver Transplantation.

Background: The management of inflammatory bowel disease [IBD] patients with concurrent liver transplantation is challenging, and data regarding the safety and efficacy of Janus kinase [JAK] inhibitors with anti-rejection medications are required. We report the experience of all liver transplant recipients receiving tofacitinib and/or upadacitinib for IBD across three states in Australia.

Methods: All liver transplant recipients from the Australian states of Victoria, New South Wales, and Tasmania, who required tofacitinib or upadacitinib for the treatment of IBD, were identified using prospectively maintained liver transplant databases. Patients were followed up until medication cessation or last follow-up. Clinical safety and efficacy data were collected.

Results: Eight patients [median age 30 years] were included, seven of whom received first-line JAK inhibition with tofacitinib. All patients had failed one or more biologic therapies prior to commencing JAK inhibition, including six patients who had failed two or more agents. JAK inhibition was continued for a median of 17 months, with 143 patient-months of combined follow-up. The anti-rejection medication tacrolimus was prescribed in all patients. Overall, seven [88%] patients achieved clinical remission, including all three patients who were switched from tofacitinib to upadacitinib. One patient required colectomy after 1 month of treatment. There were no other cases of serious infection, venous thromboembolism, or major adverse cardiovascular events during follow-up.

Conclusions: As the largest case series to date, these data indicate that combining JAK inhibition with transplant anti-rejection medication may be a safe and clinically effective method of treating IBD in patients with prior biologic failure.

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