While JAK and interleukin (IL)-23 inhibitors have rapidly entered routine care for ulcerative colitis (UC), the ideal maintenance doses remain unclear.
"The unresolved question is: Which patient actually needs the higher maintenance dose?" said Rahul Dalal, MD, MPH, a gastroenterologist at Brigham and Women's Hospital and Harvard Medical School in Boston. "Is it the patient with severe endoscopic disease, extensive colitis, prior advanced therapy failure, steroid dependence, high fecal calprotectin, or only a partial induction response? We have clinical instincts, but we do not yet have a precise biomarker-driven algorithm."
Pivotal trials for JAK and IL-23 inhibitors weren't powered to compare dose against dose, explained Ariel Holland, PharmD, a pharmacist at Ohio State University Wexner Medical Center in Columbus.
Several of these drugs have only received FDA approval for UC within the past 2 to 4 years, meaning clinicians have fairly little experience with them.
Weighing the Options
