SAFETY OF JANUS KINASE INHIBITORS FOR THE MANAGEMENT OF OLDER ADULTS WITH INFLAMMATORY BOWEL DISEASE

Older adults are the fastest growing population with inflammatory bowel disease (IBD). However, they are underrepresented in clinical trials evaluating safety and efficacy of advanced IBD therapies. Janus kinase (JAK) inhibitors are a novel class of oral small molecules for IBD with limited safety data in the older adult population. We aimed to assess the safety of tofacitinib and upadacitinib in older adults (≥ 50 years) with moderate to severe IBD.

This was a single-center retrospective cohort study at an academic hospital of older adults (≥ 50 years) treated with JAK-inhibitor monotherapy for IBD between January 2015-2024. Demographic information, primary medical history, and safety outcomes were collected.

109 patients (mean 58.4 years) were included with 44% female and 61% male. The most common adverse event (AE) was mild infection, seen in 23% of patients with no difference between upadacitinib and tofacitinib. Upper respiratory infection (10%) was the most common infection followed by skin infection (5%). Two patients on upadacitinib required hospitalization for a serious infection. Additional AE included liver enzyme abnormalities (7%) and new skin cancers (2%). Discontinuation due to AE was significantly higher in tofacitinib group (9%) compared to that in upadacitinib group (0%) (p=0.027).

Older adults ≥ 50 years undergoing treatment for IBD with JAK-inhibitors were found to have 23% risk of mild infection with a 3% risk of infection requiring hospitalization. There were no major differences in adverse events among upadacitinib and tofacitinib except for discontinuation due to adverse event.