Abstract

Perioperative safety of tofacitinib in surgical ulcerative colitis patients

Colorectal Dis. 2021 Aug;23(8):2085-2090. doi: 10.1111/codi.15702. Epub 2021 May 24.

Amy L Lightner 1, Prashansha Vaidya 1, Stefan Holubar 1, Janindra Warusavitarne 2, Kapil Sahnan 2, Francesco Maria Carrano 3 4, Antonino Spinelli 4, Karen Zaghiyan 5, Phillip R Fleshner 5

 
     

Author information

  • 1Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA.
  • 2Division of Colon and Rectal Surgery, St Marks Hospital, London, UK.
  • 3Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center, Colon and Rectal Surgery Unit, Rozzano, Milan, Italy.
  • 4Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy.
  • 5Division of Colon and Rectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Abstract

Aim: The literature regarding monoclonal antibodies and increased postoperative complications in inflammatory bowel disease remains controversial. There have been no studies investigating tofacitinib. The aim of this work was to determine preoperative exposure to the small-molecule inhibitor tofacitinib and postoperative outcomes.

Method: We conducted a retrospective review of all adult patients exposed to tofacitinib within 4 weeks of total abdominal colectomy for medically refractory ulcerative colitis between 1 January 2018 and 1 September 2020 at four inflammatory bowel disease referral centres. Data collected included patient demographics and 90-day postoperative morbidity, readmission and reoperation rates.

Results: Fifty-three patients (32 men, 60%) with ulcerative colitis underwent a total abdominal colectomy (n = 50 laparoscopic, 94%) for medically refractory disease. Previous exposure to monoclonal antibodies included infliximab (n = 34), adalimumab (n = 35), certolizumab pegol (n = 5), vedolizumab (n = 33) and ustekinumab (n = 10). Twenty-seven (51%) patients were on concurrent prednisone at a median daily dose of 30 mg by mouth (range 5-60 mg). There were no postoperative deaths. Ninety-day postoperative complications included ileus (n = 7, 13.2%), superficial surgical site infection (n = 4, 7.5%), intra-abdominal abscess (n = 2, 3.8%) and venous thromboembolism (VTE) (n = 7, 13.2%). Locations of VTE included portomesenteric venous thrombus (n = 4), internal iliac vein (n = 2) and pulmonary embolism (n = 1). Nine (17%) patients were readmitted to hospital and five (9%) patients had a reoperation.

Conclusion: Mirroring the recently issued US Food and Drug Administration black box warning of an increased risk of VTE in medically treated ulcerative colitis patients taking tofacitinib, preoperative tofacitinib exposure may present an increased risk of postoperative VTE events. Consideration should be given for prolonged VTE prophylaxis on hospital discharge.

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