Abstract Background Janus kinase (JAK) inhibitors have been reported to be useful in acute severe ulcerative colitis (ASUC). We performed a systematic review and meta-analysis to assess their effectiveness and safety in ASUC. Methods Electronic databases (PubMed, Embase, and Scopus) were searched on 18th March 2025 to identify reports about using JAK inhibitors in ASUC. We extracted data concerning clinical response, remission, colectomy, and adverse events with the use of JAK inhibitors in ASUC. Pooled clinical response rates, remission rates and colectomy were calculated at short-term (30 days), intermediate (3 months) and long-term (3-12 months) therapy. The quality of studies was assessed using Joanna-Briggs’ tools. Results A total of 33 studies (650 patients) were included. In the short term (1 month), the pooled clinical response and colectomy rate with upadacitinib was 0.84 95% CI; 0.68-0.93 and 0.1195% CI: 0.06-0.20 while for tofacitinib it was 0.78 95%CI; 0.69-0.86 and 0.13 95%CI: 0.08-0.21, respectively. In the intermediate term ( 3 months) the pooled clinical response, remission and colectomy rates with upadacitinib and tofacitinib were 0.56 95%CI: 0.39-0.72, 0.47 95%CI: 0.36-0.59, 0.21 95% CI: 0.15-0.28, and 0.57 95% CI: 0.49-0.65, 0.37 95% CI: 0.28-0.48, 0.18 95% CI: 0.12-0.26 respectively. In the long term (3-12 months) the pooled clinical response, remission and colectomy rates with upadacitinib and tofacitinib were 0.30 95%CI:0.21-0.42, 0.27 95% CI: 0.17-0.40, 0.25 95%CI: 0.17-0.34 and 0.41 95%CI: 0.34-0.49, 0.34 95%CI: 0.28-0.40, 0.24 95% CI: 0.18-0.31 respectively. The adverse events reported were venous thromboembolism (5 patients, 0.91%), major adverse cardiovascular events (4 patients, 0.73%), and herpes (10 patients, 1.83%). There was no difference in the effectiveness of high-dose as compared to standard-dose tofacitinib. Conclusion JAK inhibitors are effective and safe in the treatment of ASUC as an adjunct to intravenous corticosteroids and as rescue therapy. Randomised controlled trials evaluating the role of JAK inhibitors as co-therapy with corticosteroids and as a salvage therapy agent in corticosteroid non-responsive ASUC are required. References: Conflict of interest: Dr. Jena, Anuraag: No conflict of interest Chatterjee, Abhirup: No conflict of interest Choudhury, Arup: No conflict of interest Sharma, Vishal: No conflict of interest Sebastian, Shaji: Grant: Takeda, Tillots pharma, Biogen, Pfizer, Abbvie, Johnson & Johnson, Olympus -Odin Vision Personal Fees: Tillots, Johnson & Johnson, Olympus Odin Vision, AbbVie, Takeda, Merck, Pharmacosmos, Amgen, Eli Lilly, BMS, Odin Vision Non-financial Support: Tillots, Takeda, AbbVie, Celltrion, Johnson & Johnson, Eli Lilly, Alphasigma, Ferring Pharma
Jena et al. (2026) studied this question.