Comparison between tofacitinib and ustekinumab as a third-line therapy in refractory ulcerative colitis: A multicenter international study

BACKGROUND

Ustekinumab and tofacitinib have recently been approved for the management of moderate to severe ulcerative colitis (UC). However, there is no evidence on how they should be positioned in the therapeutic algorithm. The aim of this study was to compare tofacitinib and ustekinumab as third-line therapies in UC patients in whom anti-TNF and vedolizumab had failed.

METHODS

This was a multicenter retrospective observational study. The primary outcome was disease progression, defined as the need for steroids, therapy escalation, UC-related hospitalization and/or surgery. Secondary outcomes were clinical remission, normalization of C-reactive protein, endoscopic remission, treatment withdrawal, and adverse events.

RESULTS

One-hundred seventeen UC patients were included in the study and followed for a median time of 11.6 months (q1 -q3, 5.5-18.7). Overall, 65% of patients were treated with tofacitinib and 35% with ustekinumab. In the entire study cohort, 63 patients (54%) had disease progression during the follow-up period. Treatment with ustekinumab predicted increased risk of disease progression compared to treatment with tofacitinib in Cox regression analysis (HR: 1.93 [95% CI: 1.06-3.50] p = 0.030). Twenty-eight (68%) patients in the ustekinumab group and 35 (46%) in the tofacitinib group had disease progression over the follow-up period (log-rank test, p < 0.054). No significant differences were observed for the secondary outcomes. Six and 22 adverse events occurred in the ustekinumab and tofacitinib groups, respectively (15% vs. 31%, p = 0.11).

CONCLUSIONS

Tofacitinib was more efficacious in reducing disease progression than ustekinumab in this cohort of refractory UC patients. However, prospective head-to-head clinical trials are needed as to confirm these data.

Multiple timescales in the photoswitching kinetics of crystalline thin films of azobenzene-trimers

Functional materials that exhibit photoinduced structural phase transitions are highly interesting for applications in optomechanics and mechanochemistry. It is, however, still not fully understood how photochemical reactions, which are often accompanied by molecular motion, proceed in confined and crystalline environments. Here we show that thin films of azobenzene trimers exhibit high structural order and determine the crystallographic unit cell. We demonstrate that thin film can be switched partially reversibly between a crystalline and an amorphous phase. The time constant of the photoinduced amorphisation as measured with real-time x-ray diffraction ([Formula: see text]220 s) lies between the two time constants (120 s and 2870 s) of the ensemble photoisomerisation processes that are measured via optical spectroscopy. Our observation of a photoinduced shrinking of the crystalline domains indicates a cascading process, in which photoisomerisation starts at the surface of the thin film and propagates deeper into the crystalline layer by introducing disorder and generating free volume. This finding is important for the rapidly evolving research field of photoresponsive thin films and smart crystalline materials in general.

In situ studies of NO reduction by H2 over Pt using surface X-ray diffraction and transmission electron microscopy

Exposure to H₂ induces faceting of the Pt nanoparticle, while exposure to NO induces rounding of the nanoparticle.