Posted 6/27/2018 11:11 PM (GMT -5)
I've been looking at drug options since I'm still showing disappointingly high calprotectin scores. We're going to do one more test before discussing a treatment change. I've seen some conflicting information online regarding Xeljanz, so wanted to share the highlights of what I read:
TL;DR: fast onset of action (2 weeks). More stringent requirements for remission in the Xeljanz trials than the Entyvio trials. Those previously treated with anti-TNF and/or those who failed anti-TNF responded to Xeljanz similarly to other patient populations. Xeljanz has a different mechanism of action than anti-TNFs (Remicade, Humira, Simponi) or anti-integrin drugs (Entyvio).
https://www.nejm.org/doi/full/10.1056/NEJMoa1606910
"In two identical phase 3 trials of induction therapy with tofacitinib in patients with moderately to severely active ulcerative colitis, the rates of remission at 8 weeks were significantly higher among those who received oral tofacitinib at a dose of 10 mg twice daily than among those who received placebo. The rates of mucosal healing and clinical response at 8 weeks were significantly higher and improvements in health-related quality of life were significantly greater with tofacitinib than with placebo. The onset of action was rapid, with significant improvement in the partial Mayo score observed at 2 weeks (the first assessment of the partial Mayo score after the baseline assessment)."
"The OCTAVE trials incorporated a more stringent definition of remission (with the additional requirement of a rectal bleeding subscore of 0) than the definition used in previous trials of treatments for ulcerative colitis, such as the GEMINI 1 trial.3 Furthermore, efficacy analyses in the OCTAVE trials were based on a centrally assessed Mayo endoscopic subscore. Analyses in prespecified subgroups, including subgroups defined according to previous treatment with TNF antagonists and treatment failure with TNF antagonists, showed a generally consistent treatment effect across most patient populations."