S1476 Comparative Outcomes of Tofacitinib Initiation in Biologic-Naïve vs Biologic-Experienced Ulcerative Colitis Patients: A Retrospective Cohort Analysis

Introduction: While tofacitinib is approved for moderate-to-severe ulcerative colitis (UC), it remains unclear whether prior exposure to biologic therapies modifies its safety and effectiveness. We compared 6-month risks of complication-related hospitalization and partial colectomy after tofacitinib initiation in biologic-naïve vs biologic-experienced UC patients. Methods: This retrospective cohort study used the USA TriNetX Collaborative Network to identify adult (≥18 years) UC patients who newly initiated tofacitinib between January 1, 2019, and December 31, 2024. Patients were stratified into biologic-experienced (“non-naïve”) and biologic-naïve cohorts. Propensity-score matching (1:1) balanced age, sex, race, and baseline disease characteristics, yielding 516 patients per group. The primary outcome was hospitalization for UC with complications within 6 months; the secondary outcome was partial colectomy. Univariable risk ratios (RRs) with 95% confidence intervals (CIs) and P values were calculated in each matched cohort. Results: After propensity score matching, 516 patients were included in each group. The overall cohort’s mean ± SD age was 45.7 ± 17.3 years, with 49% men and the majority White (76%). Matching achieved good balance across baseline characteristics (all standardized differences < 0.10). The risk of ulcerative colitis related complications was similar between non–biologic-naïve and biologic-naïve patients at 29.07% vs 28.88% (RR 1.007; 95% CI, 0.832–1.219; P = 0.945). Likewise, partial colectomy rates did not differ significantly (4.26% vs 5.23%; RR 0.815; 95% CI, 0.471–1.412; P = 0.464). Conclusion: Among UC patients initiating tofacitinib, prior biologic exposure did not significantly influence 6-month complication-related hospitalization or colectomy rates. These findings support comparable safety and effectiveness of tofacitinib irrespective of biologic history.