Background/Aims: Tofacitinib and upadacitinib are small-molecule compounds that inhibit the Janus kinase pathway for the treatment of refractory ulcerative colitis. Only a few reports have compared the efficacy and safety of these 2 drugs in real-world practice. We aimed to show our real-world evidence of these drugs and compare the efficacy and safety profiles in the treatment of ulcerative colitis. Methods: This study is a single-center retrospective analysis. Patients treated with tofacitinib or upadacitinib at our hospital between June 2018 and January 2024 who were monitored for 24 weeks were included. The primary outcome was steroid-free clinical remission at 24 weeks. Secondary outcomes were response and remission rates at each time point, time series changes in partial Mayo scores and laboratory results, treatment survival at 24 weeks, and the incidence of adverse events. Results: A total of 68 patients treated with tofacitinib and 34 patients treated with upadacitinib were included. Steroid-free clinical remission rate at 24 weeks was significantly higher in upadacitinib-treated patients than in tofacitinibtreated patients (64.7% vs. 38.2%). The response rates in upadacitinib-treated patients exceeded 60% after 8 weeks of treatment through to 24 weeks, and the rates were higher than those in tofacitinib-treated patients. The incidences of adverse events were 79.4% in upadacitinib-treated patients and 38.2% in tofacitinib-treated patients. The most common adverse event was acne for upadacitinib. Conclusions Upadacitinib was more effective than tofacitinib in inducing remission in ulcerative colitis patients. The incidence of adverse events was significantly higher with upadacitinib than tofacitinib.

Background: Hot spring inhalation and rock bathing are widely practiced in Europe, and immersion in water up to the shoulders is popular in Japanese balneotherapy. We designed a combination therapy of steam rock bathing and immersion in an open-air hot spring pool for allergic rhinitis.Methods: Data were obtained by anonymous questionnaires from 19 participants with perennial allergic rhinitis who underwent the combination therapy for several days during the spring-pollen season. The participants immersed themselves in a sitting position in Saiboku hot spring water (sodium salt hot spring) at 41°C up to the shoulder level for 10 min in the open-air and then lay on a floor paved with small rocks in a supine position for 20 min in a room filled with the steam from hot springs, then immersed themselves again in the hot spring water for 10 min, and finally rested and sat on a chair for 20 min in a comfortable room. The hot spring water circulated through tubes with small holes that were embedded under the floor, which was paved with small rocks consisting of tourmaline and lime stones. Steam from the hot spring water penetrated through the floor and vaporized in the room. The rock bathing room was 40°C in temperature and 75% in humidity.Results: Clinical symptoms were alleviated in 17 of 19 participants. Watery rhinorrhea, eye itching, sneeze, and sore throat were improved in 100%, 75%, 40%, and 100% of the participants, respectively, compared with symptoms during the previous several years. No adverse effects were observed in any participants. Conclusion: Steam rock bathing, combined with immersion in an open-air hot spring pool, is useful in ameliorating the focal and systemic symptoms of allergic rhinitis.