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This narrative review synthesizes evidence from randomized controlled trials (RCTs), observational studies, and systematic reviews. The efficacy of tofacitinib has been documented, with an 83.01% day-7 response rate in the TACOS trial and 79.9%\u201386% 90-day colectomy-free survival in steroid-refractory ASUC. However, seven unmet needs impede the adoption of tofacitinib treatment for managing ASUC: (1) a lack of head-to-head RCTs comparing tofacitinib not only to standard rescue therapies like infliximab and ciclosporin but also to other JAK inhibitors like upadacitinib, (2) uncertainty in optimal dosing and duration, (3) ambiguity in positioning tofacitinib in the treatment algorithm, (4) undefined patient selection criteria, notably for those with prior biologic exposure, (5) limited long-term efficacy and cost-utilization data, (6) unresolved safety risks (e.g., infections, thrombosis), and (7) underexplored potential for combination therapy. These gaps undermine the widespread use of tofacitinib in reducing surgical burden and improving outcomes. Collaborative research\u2014especially multi-center RCTs comparing tofacitinib to infliximab, ciclosporin, and next-generation JAK inhibitors\u2014is vital for establishing evidence-based protocols. Addressing these needs could optimize tofacitinib-based ASUC management, offering a rapid, oral alternative to enhance patient care.<\/jats:p>","DOI":"10.1177\/17562848251374638","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T08:16:41Z","timestamp":1757578601000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Tofacitinib in acute severe ulcerative colitis: review addressing seven key unmet needs"],"prefix":"10.1177","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7703-0932","authenticated-orcid":false,"given":"Chuong Dinh","family":"Nguyen","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, University Medical Center, Ho Chi Minh City, Vietnam"},{"name":"Clinical Sciences (International Program), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9295-4308","authenticated-orcid":false,"given":"Luan Minh","family":"Dang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, University Medical Center Ho Chi Minh City, 215 Hong Bang Street, Cho Lon Ward, Ho Chi Minh City 700000, Vietnam"},{"name":"Department of Internal Medicine, School of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4151-7861","authenticated-orcid":false,"given":"Thong Duy","family":"Vo","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, University Medical Center, Ho Chi Minh City, Vietnam"},{"name":"Department of Internal Medicine, School of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hoang Huu","family":"Bui","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, University Medical Center, Ho Chi Minh City, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0806-9136","authenticated-orcid":false,"given":"Eun Soo","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5221-7349","authenticated-orcid":false,"given":"Joyce Wing Yan","family":"Mak","sequence":"additional","affiliation":[{"name":"Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8961-5455","authenticated-orcid":false,"given":"Choon Jin","family":"Ooi","sequence":"additional","affiliation":[{"name":"Gleneagles Medical Centre, Singapore"},{"name":"Duke-NUS Medical School, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,9,11]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.2.4947.1041"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/ibd\/izy383"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrgastro.2016.116"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2016.7"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/627370"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/jgh3.12933"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000003463"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/ecco-jcc\/jjab178"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2022.08.039"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1080\/1744666X.2017.1291342"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1606910"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000002635"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2023.05.021"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2021.05.038"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/ecco-jcc\/jjad036"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.5217\/ir.2023.00194"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000002145"},{"issue":"1","key":"e_1_3_4_19_2","first-page":"2025","article-title":"Tofacitinib for hospitalized acute severe ulcerative colitis management (the TRIUMPH study)","volume":"360","author":"Narula N","unstructured":"Narula N, Pray C, Hamam H, et al. 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