Anti-interleukins, JAK inhibitors linked with lower infection risk in ulcerative colitis

Anti-interleukins and Janus kinase (JAK) inhibitors were associated with a lower risk of serious infections than other drug classes in patients with ulcerative colitis and may offer a net benefit, an observational study found.

Researchers used an administrative claims database to identify patients with ulcerative colitis (mean age, 47 years; 49.2% female) who initiated tumor necrosis factor (TNF) antagonists (n=4,111), anti-integrin agents (n=3,165), anti-interleukins (n=1,342), JAK inhibitors (n=701), or sphingosine-1 phosphate receptor (S1PR) modulators (n=111) in January 2016 to December 2022. Patients were followed for a median of 27 months. The authors compared risk of serious infections, venous thromboembolism (VTE), and major adverse cardiovascular events (MACE) among treatments. Findings were published by the American Journal of Gastroenterology on Oct. 22.

After adjustment, anti-interleukins were associated with a lower risk of serious infections compared with both TNF antagonists (hazard ratio [HR], 0.66; 95% CI, 0.51 to 0.87) and anti-integrins (HR, 0.75; 95% CI, 0.57 to 0.98). JAK inhibitors were also associated with a lower risk of serious infections compared with TNF antagonists (HR, 0.66; 95% CI, 0.46 to 0.94). The most common serious GI infection was Clostridioides difficile, and sepsis, pneumonia, and urinary tract infection were the most common extraintestinal infections. Incidence of VTE (incidence rate, 1.4 to 2.0 per 100 person-years) and MACE (0.5 to 1.0 per 100 person-years) was very low, and there were no significant differences across drug classes.

Limitations include a lack of data on disease activity or endoscopy reports. Researchers also could not rule out the possibility of residual confounding.

“Future prospective head-to-head clinical trials examining this efficacy-safety synergy with JAK inhibitors compared with other agents are warranted in patients with [ulcerative colitis],” the study authors wrote. “These findings will inform optimal choice of different advanced therapies in patients with ulcerative colitis depending on a patient's risk of disease- and treatment-related complications.”