{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T08:02:47Z","timestamp":1793865767892,"version":"4.6.1"},"reference-count":57,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,3,30]],"date-time":"2025-03-30T00:00:00Z","timestamp":1743292800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,3,30]],"date-time":"2025-03-30T00:00:00Z","timestamp":1743292800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Therap Adv Gastroenterol"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:p>\n                    Acute severe ulcerative colitis (ASUC) is a life-threatening medical emergency affecting over 20% of patients with ulcerative colitis (UC). Up to 40% of patients are refractory to intravenous corticosteroids (IVCS) and require rescue medical therapy or immediate colectomy. The potent Janus kinase (JAK) inhibitors, upadacitinib and tofacitinib, have proven efficacy in a randomised control trial setting for moderate-to-severe UC, but not ASUC. We describe a case series of sequential rescue therapy with JAK inhibitors following the failure of dose-intensified infliximab in corticosteroid-refractory ASUC. Six adult (&gt;16\u2009years old) patients received sequential rescue therapy with a JAK inhibitor (upadacitinib\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    \u2009=\u20095, tofacitinib\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    \u2009=\u20091) following failure of IVCS and dose-intensified infliximab at the Royal Brisbane and Women\u2019s Hospital (QLD, Australia) between October 2023 and April 2024. All patients met the Truelove and Witts criteria for ASUC on admission. Data were captured during admission and at 90-days post-discharge. Co-primary outcomes were 90-day colectomy-free survival and inpatient clinical response (&lt;4 non-bloody stools per day) 72\u2009h after JAK-inhibitor initiation. Secondary outcomes included 90-day clinical (PRO-2 score\u2009&lt;\u20091) and biochemical (faecal calprotectin (FCP)\u2009&lt;\u2009150\u2009\u00b5g\/g and C-reactive protein (CRP)\u2009&lt;\u20095\u2009mg\/L) corticosteroid-free remission and adverse events. Median CRP on admission was 100\u2009mg\/L (interquartile range (IQR) 58\u2013105), median FCP 3400\u2009\u00b5g\/g (IQR 910\u20134950) and median Mayo Endoscopic Score 3. Four out of six patients had a clinical response within 72\u2009h of sequential JAK-inhibitor rescue therapy. Two patients underwent emergent inpatient colectomy for refractory disease \u2013 one of whom developed post-operative sepsis. Among the four JAK-responders at 90\u2009days, all achieved corticosteroid-free clinical remission and three achieved biochemical remission. No other adverse events were recorded. There is a promising role for JAK inhibitors as sequential rescue therapy following the failure of dose-intensified infliximab in select patients with corticosteroid-refractory ASUC.\n                  <\/jats:p>","DOI":"10.1177\/17562848251323511","type":"journal-article","created":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T00:46:22Z","timestamp":1743381982000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":12,"title":["Sequential rescue therapy with JAK inhibitors in corticosteroid and infliximab-refractory acute severe ulcerative colitis: a case series"],"prefix":"10.1177","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-0337-8463","authenticated-orcid":false,"given":"Amirah","family":"Etchegaray","sequence":"first","affiliation":[{"name":"Royal Brisbane and Women\u2019s Hospital, Brisbane, QLD, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8785-7661","authenticated-orcid":false,"given":"George","family":"Tambakis","sequence":"additional","affiliation":[{"name":"Royal Brisbane and Women\u2019s Hospital, Brisbane, QLD, Australia"},{"name":"University of Queensland, Brisbane, QLD, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9225-7879","authenticated-orcid":false,"given":"Rina","family":"Kumar","sequence":"additional","affiliation":[{"name":"QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Croft","sequence":"additional","affiliation":[{"name":"Royal Brisbane and Women\u2019s Hospital, Brisbane, QLD, Australia"},{"name":"University of Queensland, Brisbane, QLD, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2047-6239","authenticated-orcid":false,"given":"Graham","family":"Radford-Smith","sequence":"additional","affiliation":[{"name":"Royal Brisbane and Women\u2019s Hospital, Brisbane, QLD, Australia"},{"name":"University of Queensland, Brisbane, QLD, Australia"},{"name":"QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3883-8816","authenticated-orcid":false,"given":"Gareth J.","family":"Walker","sequence":"additional","affiliation":[{"name":"Clinical Lead for IBD and Research, Department of Gastroenterology, Royal Brisbane and Women\u2019s Hospital, Herston, Brisbane QLD, 4029, Australia"},{"name":"UQ Centre for Clinical Research (UQCCR), Faculty of Health, Medicine, and Behavioural Sciences, University of Queensland, Brisbane, QLD, 4006, Australia"},{"name":"Infection and Inflammation Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,3,30]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.crohns.2010.02.001"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2016.7"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61084-8"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(16)30003-6"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/apt.12375"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2005.03.003"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(21)00016-9"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2012.333"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2007.03415.x"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2014.07.041"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-018-5407-7"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(24)00200-0"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2011.04934.x"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2011.62"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2008.04.035"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)00581-5"},{"key":"e_1_3_6_18_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1606910"},{"key":"e_1_3_6_19_2","doi-asserted-by":"publisher","DOI":"10.1111\/apt.17816"},{"key":"e_1_3_6_20_2","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000002145"},{"key":"e_1_3_6_21_2","doi-asserted-by":"crossref","unstructured":"Lichtenstein GR Tinsley A Roblin X et al. 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