Perioperative Safety of Tofacitinib in Surgical Ulcerative Colitis Patients

Background Literature regarding monoclonal antibodies and increased postoperative complications in inflammatory bowel disease remains controversial. No study has investigated tofacitinib. We sought to determine preoperative exposure to small molecule inhibitors, tofacitinib, and postoperative outcomes. Methods A retrospective review of all adult patients exposed to tofacitinib within 4 weeks of total abdominal colectomy for medically refractory ulcerative colitis between 1/1/2018-9/1/2020 at four inflammatory bowel disease referral centers was conducted. Data collected included patient demographics and 90-day postoperative morbidity, readmission and reoperation rates. Results Fifty-three patients (32 male; 60%) with ulcerative colitis underwent a total abdominal colectomy (n=50 laparoscopic; 94%) for medically refractory disease. Previous monoclonal antibody exposure included infliximab (n=34), adalimumab (n=35), certolizumab pegol (n=5), vedolizumab (n=33), and ustekinumab (n=10). Twenty seven (51%) patients were on concurrent prednisone at a median dose of 30 mg po daily (range, 5-60 mg). There were no postoperative deaths. Ninety day postoperative complications included ileus (n=7; 13.2%), superficial surgical site infection (n=4;7.5%), intra-abdominal abscess (n=2; 3.8%), and venous thromboembolism (VTE) (n=7; 13.2%). Locations of VTE included portomesenteric venous thrombus (PMVT) (n=4), internal iliac vein (n=2), and pulmonary embolism (PE) (n=1). Nine (17%) patients were readmitted to hospital and 5 (9%) patients had a reoperation. Conclusion Mirroring the recently issued Food and Drug Administration black box warning of an increased risk of VTE in medically treated ulcerative colitis patients taking tofacitinib, preoperative tofacitinib exposure may present an increased risk of postoperative VTE events. Consideration should be given for prolonged VTE prophylaxis on hospital discharge.