The Effects of 5‐Aminosalicylic Acid on Janus Kinase Inhibitor Treatment in Ulcerative Colitis

To the Editors, we read with interest the article by Nishida et al. [1] investigating the effects of aminosalicylic acid (5-ASA) combined with tofacitinib in ulcerative colitis (UC) patients. They found that concomitant 5-ASA use reduced the risk of relapse in patients on 5 mg tofacitinib BID, suggesting benefits at lower doses. Their findings are important to current clinical practice and future research; we have also performed a retrospective cohort study to evaluate the effects of 5-ASA combined with Janus kinase (JAK) inhibitors including tofacitinib and upadacitinib in UC patients. A total of 156 UC patients participated in this study between January 2020 and October 2024, including 66 (42.3%) women and 90 (57.7%) men. Among these patients, 42 were in tofacitinib 5 mg group, 42 were in tofacitinib 10 mg group, 42 were in upadacitinib 45 mg/30 mg group, and 42 were in upadacitinib 45 mg/15 mg group. Within our cohort, 64.9% of the patients in the tofacitinib 5 mg group and 76.2% of the patients in the tofacitinib 10 mg group received concomitant 5-ASA, 74.4% of the patients in the upadacitinib 45 mg/30 mg group, and 70.6% of the patients in the upadacitinib 45 mg/15 mg group received concomitant 5-ASA. The median disease duration was 1.2, 1.4, 1.2, and 1.5 years in the tofacitinib 5 mg with 5-ASA group, tofacitinib 10 mg with 5-ASA group, tofacitinib 5 mg, and tofacitinib 10 mg, respectively. The median disease duration was 1.3, 1.4, 1.2, and 1.1 years in the upadacitinib 45 mg/30 mg with 5-ASA group, upadacitinib 45 mg/15 mg with 5-ASA group, upadacitinib 45 mg/30 mg, and upadacitinib 45 mg/15 mg, respectively. According to the Montreal classification, the number of patients with E1, E2, and E3 was 36, 87, and 33. Table 1 presents the overall demographic characteristics and provides a detailed comparison between the groups using and not using 5-ASA in the JAK inhibitor group. There were no significant differences about C-reactive protein, fecal calprotectin, hemoglobin, and albumin among these groups. Of the 156 patients, 20 (12.8%) experienced clinical relapse, and 38 (19.2%) experienced endoscopic relapse at the follow-up of 6 months. Of these, 13.6% (6 of 44) of patients not using concomitant 5-ASA clinical relapsed, compared to 12.5% (14 of 112) of those using concomitant 5-ASA. A total of 25% (11 of 44) of patients not using concomitant 5-ASA endoscopic relapsed, compared to 24.1% (27 of 112) of those using concomitant 5-ASA. No significant differences were noted in the clinical and endoscopic relapse rates between patients using only JAK inhibitors and using JAK inhibitors with 5-ASA. At the same time, there were no significant differences about the clinical and endoscopic relapse rates between patients with tofacitinib and upadacitinib. In conclusion, our retrospective cohort study indicated that the concomitant use of 5-ASA cannot offers protective benefits when using JAK inhibitors to treat UC. However, further research is needed to confirm our findings and understand the mechanisms involved. The authors declare no conflicts of interest.

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