Optimal use and cycling strategies of Janus kinase inhibitors in ulcerative colitis: current evidence and clinical implications from the KASID Guidelines Task Force Team
- Author:
Seung Min HONG
1
;
Dong Hyun KIM
;
June Hwa BAE
;
Seung Yong SHIN
;
Eun Mi SONG
;
Ji Eun KIM
;
Young Joo YANG
;
Jiyoung YOON
;
Sang-Bum KANG
;
Eun Soo KIM
;
Seong-Eun KIM
;
Seong-Jung KIM
;
Jun LEE
;
Soo-Young NA
;
Soo Jung PARK
;
Sang Hyoung PARK
;
Miyoung CHOI
;
Myung Ha KIM
;
Won MOON
;
Sung-Ae JUNG
;
Author Information
- Publication Type:Review
- From:Intestinal Research 2026;24(1):27-37
- CountryRepublic of Korea
- Language:English
- Abstract: Janus kinase (JAK) inhibitors are an important treatment option for ulcerative colitis, providing rapid onset of action, oral administration, and efficacy even after biologic failure. The 3 approved agents—tofacitinib, filgotinib, and upadacitinib—differ in JAK isoform selectivity, leading to clinically meaningful differences in efficacy and safety. Evidence from network meta-analyses, clinical trials, and real-world studies consistently shows that upadacitinib provides the highest efficacy for induction and maintenance of remission, whereas filgotinib demonstrates the most favorable safety profile. The strong efficacy of upadacitinib and tofacitinib is particularly relevant in patients with severe disease, including acute severe ulcerative colitis, and upadacitinib maintains high efficacy regardless of prior advanced therapy exposure. JAK inhibitors also benefit extraintestinal manifestations. Although risks such as herpes zoster, serious infection, thromboembolism, and major cardiovascular events differ among agents, long-term data suggest generally acceptable safety when used appropriately. Intraclass JAK-to-JAK cycling is feasible, with about half of patients achieving steroid-free clinical remission in retrospective cohorts. Based on mechanistic, clinical, and real-world evidence, filgotinib may be a first-line option for patients with lower disease activity or when safety is a priority, whereas upadacitinib or tofacitinib may be preferred in higher disease activity. Strategically selecting agents may improve durability and outcomes.
