Efficacy and safety of tofacitinib dose de-escalation and dose escalation for patients with ulcerative colitis: results from OCTAVE Open

BACKGROUND

For patients with UC, flexible maintenance dosing therapy may confer advantages for safety, efficacy, costs and patient preference. Tofacitinib is an oral, small molecule JAK inhibitor for the treatment of UC.

AIM

To assess the efficacy and safety of tofacitinib dose de-escalation and escalation in patients with UC.

METHODS

We evaluated data (November 2017 data cut-off) from OCTAVE Open, an ongoing, open-label, long-term extension study. The dose de-escalation group comprised 66 tofacitinib induction responders in remission following 52 weeks' tofacitinib 10 mg b.d. maintenance therapy, subsequently de-escalated to 5 mg b.d. in OCTAVE Open. The dose escalation group comprised 57 tofacitinib induction responders who experienced treatment failure while receiving 5 mg b.d. maintenance therapy, subsequently escalated to 10 mg b.d. in OCTAVE Open.

RESULTS

After tofacitinib de-escalation, 92.4% (61/66) and 84.1% (53/63) of patients maintained clinical response and 80.3% (53/66) and 74.6% (47/63) maintained remission, at months 2 and 12, respectively. After dose escalation, 57.9% (33/57) and 64.9% (37/57) of patients recaptured clinical response and 35.1% (20/57) and 49.1% (28/57) were in remission, at months 2 and 12, respectively. The incidence rate of herpes zoster with dose escalation (7.6 patients with events/100 patient-years) was numerically higher than in the overall tofacitinib UC programme.

CONCLUSIONS

Following tofacitinib de-escalation in patients already in remission on 10 mg b.d., most maintained remission, although 25.4% lost remission, at month 12. For induction responders who dose-escalated following treatment failure on 5 mg b.d. maintenance therapy, 49.1% achieved remission by month 12. (ClinicalTrials.gov number: NCT01470612).

Chronic aortic denervation decreases anxiety and impairs social memory in rats

AIMS

The present study investigates anxiety-like behaviour and social cognitive performance in rats with chronic aortic denervation.

MAIN METHODS

The aortic depressor nerve was bilaterally transected in Wistar rats, causing an almost complete disruption of baroreceptors. Bilateral aortic denervated (bAD), sham-operated (SHAM), and intact (CTRL) rats performed an elevated plus-maze test and an olfactory social memory test, one and three months after operation. Blood pressure and heart rate were monitored in all animals.

KEY FINDINGS

Systolic blood pressure, blood pressure lability and heart rate were elevated in bAD rats compared to SHAM and CTRL rats. In the elevated plus-maze test, bAD rats spent clearly more time in investigating open arms and performed more open arm entries than SHAM and CTRL rats during both testing sessions. The olfactory social memory test revealed that acquisition time during first contact with a juvenile rat did not differ between the groups of rats. The recognition time spent by SHAM and CTRL group of rats was distinctly decreased in comparison to the acquisition time, an indication of social memory. bAD rats investigated the juvenile rat during the second contact to a similar extent than during the first contact, both one and three months after denervation.

SIGNIFICANCE

These results suggest that bilateral aortic denervation induces chronic neurogenic hypertension and elevated blood pressure lability, decreases anxiety-like behaviour and deteriorates social memory in rats while acquiring of social information is not affected.