Miguel Regueiro, MD: Results from the OCTAVE Study at ACG

While the symptoms of ulcerative colitis and Crohn’s disease can be similar for patients, many of the drugs are only effective in 1 of the diseases and not the other.

One of the drugs that falls into this category is tofacitinib, which is effective in treating ulcerative colitis, but not Crohn’s disease.

During the American College of Gastroenterology’s Annual Scientific Meeting (ACG 2019), Miguel Regueiro, MD, chair of the Department of Gastroenterology, Hepatology, and Nutrition at the Cleveland Clinic, explained in an interview with MD Magazine® the differences between the medications for the 2 diseases, as well as the main takeaways from the OCTAVE study testing tofacitinib as a treatment for ulcerative colitis.

MD Magazine: What were the results from the OCTAVE study?

Regueiro: The take-home message from the study we presented at ACG 2019 were that patients who had been on a prior anti-TNF therapy coming into the tofacitinib study for ulcerative colitis were less likely to have a response and less likely to have a response to continued treatment.

However, there were a group of patients who did benefit from tofacitinib 10 mg twice a day beyond the 8 weeks. So, my recommendation from the study are that if patients have a limited response within the first 8 weeks to tofacitinib to continue this for a second 8 weeks at 10 mg twice a day before stopping therapy.

If they've had any response at that point in my practice I continue on. If they've been on an anti-TNF they may be more refractory and less likely to respond.

MD Magazine: On the differences in treatments for Crohn’s disease and ulcerative colitis.

Regueiro: The differences in terms of treatments for Crohn's and ulcerative colitis are interesting in that many of the studies have shown a benefit for both ulcerative colitis and Crohn's.

However, there are notable acceptance there are notable exceptions to this such as tofacitinib, which is only approved for ulcerative colitis not Crohn's disease.

The reason and rationale for this is still largely not understood it probably has to do with the immunology and the cytokine profile that patients have with Crohn's and ulcerative colitis, which makes different medicines work for different diseases.