Ulcerative colitis causes ongoing inflammation in the lining of your colon. You typically need medication to keep that inflammation in check. Janus kinase (JAK) inhibitors are one of six classes of drugs that can help.
JAK is a family of enzymes. JAK inhibitors, also known as JAKis or jakinibs, stop these enzymes from working the way they normally do. This helps ease inflammation. They come in pill form, so you take them by mouth.
Two JAK inhibitors are approved for use in people with moderate to severe ulcerative colitis: tofacitinib (Xeljanz) and upadacitinib (Rinvoq). Doctors also prescribe both drugs to treat other autoimmune disorders, including rheumatoid arthritis.
Who Should Consider JAK Inhibitors for Ulcerative Colitis?
Doctors don’t typically prescribe JAK inhibitors first. The American Gastroenterological Association suggests most people with moderate to severe ulcerative colitis give biologics like infliximab (Remicade) or vedolizumab (Entyvio) a try, unless they’re taking part in a study on tofacitinib.
What Are the Benefits of JAK Inhibitors for Ulcerative Colitis?
Two clinical trials found that 17% to 18% of people with moderate to severe ulcerative colitis who took 10 milligrams of tofacitinib twice a day for 8 weeks reached remission (no symptoms). In another trial for those who showed no symptoms after 8 weeks, 41% who took 10 milligrams twice a day reached remission within a year.
In a clinical trial on people with moderate to severe ulcerative colitis who didn’t respond to biologics, 26% of those who took 45 milligrams once a day reached clinical remission.
Another benefit of JAK inhibitors is that they’re pills. Pills are easier to make than medication given as a shot or IV, so they cost less. JAK inhibitors also carry a somewhat lower risk of compromising your immunity than biologics.
What Are the Downsides of Using JAK inhibitors?
The most common side effects of tofacitinib in people with ulcerative colitis include:
- High cholesterol
- Headaches
- Upper respiratory infections
- Anemia
The most common side effects of upadacitinib in people with ulcerative colitis include:
- Headache
- Fatigue
- Acne
- Nausea
- High cholesterol
- Urinary tract infections
JAK inhibitors also carry a “boxed warning” from the FDA, which is the most serious kind. It notes that these drugs raise your risk of issues with your heart and blood vessels, including:
- Heart attack
- Stroke
- Cancer
- Blood clots
The FDA added this warning after final trial results on tofacitinib showed that people who took it had a higher rate of problems with their heart and blood vessels than those who used TNF-blocking biologics.
These risks aren’t the same for everyone. They’re most likely to happen in people with a history of heart problems, stroke, or blood clots. JAK inhibitors also carry higher health risks for current and former smokers.
As with any medication, work with your doctor to choose the best option for you. Part of that process is weighing the pros and cons based on your personal health history and risk factors. The doctor can help you decide if you’re a good fit for a JAK inhibitor or if you’d benefit more from a different type of ulcerative colitis medication.
Show Sources
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SOURCES:
American Gastroenterological Association: “Guideline: Management of Moderate to Severe Ulcerative Colitis.”
Crohn’s and Colitis Canada: “JAK Inhibitors.”
Crohn’s & Colitis Foundation: “Medication Options for Ulcerative Colitis.”
Drugs.com: “Rinvoq (upadacitinib) Receives FDA Approval for the Treatment of Adults with Moderately to Severely Active Ulcerative Colitis.”
FDA.gov: “FDA Approves New Treatment for Moderately to Severely Active Ulcerative Colitis,” “FDA Requires Warnings About Increased Risk of Serious Heart-Related Events, Cancer, Blood Clots, and Death for JAK inhibitors that Treat Certain Chronic Inflammatory Conditions.”
Handbook of Systemic Autoimmune Diseases: “Janus Kinase Inhibitors.”
Pharmaceutics: “A Comprehensive Overview of Globally Approved JAK Inhibitors.”
