Sequential JAK Inhibitor Switching in Ulcerative Colitis Patients Maintaining Remission: A Multicenter Experience

INTRODUCTION: Given the safety concerns associated with the long-term use of Janus kinase (JAK) inhibitors, establishing effective "exit strategies" is crucial for patients with ulcerative colitis (UC). This study investigated the efficacy and safety of switching from tofacitinib (TOF) or upadacitinib (UPA) to the JAK1-selective filgotinib (FIL) in patients maintaining remission. METHODS: We conducted a retrospective, multicenter study involving 13 UC patients who achieved clinical remission with TOF or UPA and subsequently switched to FIL. The primary endpoint was the cumulative non-relapse rate. RESULTS: During a median follow-up of 679 days, symptomatic relapse occurred in 53.8% (7/13) of patients. The one-year cumulative non-relapse rate was 71.4% for the TOF-switch group and 31.3% for the UPA-switch group. However, many relapses were successfully managed through temporary treatment adjustments, including FIL dose escalation or topical therapy. No serious adverse events were recorded. CONCLUSION: Sequential switching to FIL may represent a practical intermediate maintenance strategy before complete drug withdrawal, balancing disease control with potential safety benefits.