CINXE.COM

<!DOCTYPE html> <html dir="ltr" lang="en"> <head> <meta http-equiv="X-UA-Compatible" content="IE=Edge"> <meta charset="utf-8"> <meta name="viewport" content="width=device-width, initial-scale=1"> <link rel="apple-touch-icon" sizes="180x180" href="/assets/images/favicons/apple-touch-icon.png"> <link rel="icon" type="image/png" href="/assets/images/favicons/favicon-32x32.png" sizes="32x32"> <link rel="icon" type="image/png" href="/assets/images/favicons/favicon-16x16.png" sizes="16x16"> <link rel="mask-icon" href="/assets/images/favicons/safari-pinned-tab.svg" color="#5bbad5"> <meta name="description" content="Ryan Sullivan, MD, Michael Dougan, MD, PhD, and colleagues have reported the first three cases of using a Janus kinase inhibitor to treat hepatitis associated with immune checkpoint inhibitor therapy." > <title>Tofacitinib Effective in Treating Refractory ICI Hepatitis - Mass General Advances in Motion</title> <link rel="canonical" href="https://advances.massgeneral.org/digestive-health/journal.aspx?id=2637"> <meta name="specialty-detail" content="Digestive Health|/digestive-health/specialty.aspx?id=1007"> <meta name="specialty-detail" content="Oncology|/oncology/specialty.aspx?id=1008"> <meta name="specialty" content="Digestive Health"> <meta name="specialty" content="Oncology"> <meta name="topic-detail" content="Liver|/digestive-health/topic.aspx?id=1071"> <meta name="topic" content="Liver"> <meta name="pubDate" content="July 17, 2024"> <meta name="hubContentType" content="Journal"> <meta property="og:locale" content="en_US"> <meta property="og:url" content="https://advances.massgeneral.org/digestive-health/journal.aspx?id=2637"> <meta property="og:site_name" content="Mass General Advances in Motion"> <meta property="og:title" content="Tofacitinib Effective in Treating Refractory ICI Hepatitis"> <meta property="og:description" content="Ryan Sullivan, MD, Michael Dougan, MD, PhD, and colleagues have reported the first three cases of using a Janus kinase inhibitor to treat hepatitis associated with immune checkpoint inhibitor therapy."> <meta property="og:article" content="Digestive Health"> <meta property="og:article" content="Oncology"> <meta property="og:article" content="Liver"> <meta property="article:publisher" content="http://www.facebook.com/massgeneral"> <meta name="twitter:card" content="summary"> <meta name="twitter:site" content="@MassGeneralNews"> <link href="/assets/styles/index.css" rel="stylesheet"> <link href="/assets/styles/jquery-ui-min.css" rel="stylesheet"> <link href="https://use.typekit.net/sgz4evs.css" rel="stylesheet"> <script> window.dataLayer = window.dataLayer || []; dataLayer = [{ 'postType': 'Journal', 'specialty': 'Digestive Health,Oncology', 'topic': 'Liver' }]; </script> <script src="/assets/scripts/jquery-3.2.1.min.js" ></script> </head> <body>  <a class="a11y-skip-link" href="#main-content">Skip to content</a>   <script type="text/javascript"> (function(window, document, dataLayerName, id) { window[dataLayerName]=window[dataLayerName]||[],window[dataLayerName].push({start:(new Date).getTime(),event:"stg.start"});var scripts=document.getElementsByTagName('script')[0],tags=document.createElement('script'); function stgCreateCookie(a,b,c){var d="";if(c){var e=new Date;e.setTime(e.getTime()+24*c*60*60*1e3),d="; expires="+e.toUTCString()}document.cookie=a+"="+b+d+"; path=/"} var isStgDebug=(window.location.href.match("stg_debug")||document.cookie.match("stg_debug"))&&!window.location.href.match("stg_disable_debug");stgCreateCookie("stg_debug",isStgDebug?1:"",isStgDebug?14:-1); var qP=[];dataLayerName!=="dataLayer"&&qP.push("data_layer_name="+dataLayerName),isStgDebug&&qP.push("stg_debug");var qPString=qP.length>0?("?"+qP.join("&")):""; tags.async=!0,tags.src="https://mgb.containers.piwik.pro/"+id+".js"+qPString,scripts.parentNode.insertBefore(tags,scripts); !function(a,n,i){a[n]=a[n]||{};for(var c=0;c<i.length;c++)!function(i){a[n][i]=a[n][i]||{},a[n][i].api=a[n][i].api||function(){var a=[].slice.call(arguments,0);"string"==typeof a[0]&&window[dataLayerName].push({event:n+"."+i+":"+a[0],parameters:[].slice.call(arguments,1)})}}(i[c])}(window,"ppms",["tm","cm"]); })(window, document, 'dataLayer', '41b8ae76-3079-47d5-aaf8-040ee367d152'); </script>  <header class="site-header" data-header="main"> <div class="site-header__nav-container"> <span class="site-header__logo"> <a href="https://www.massgeneral.org">Massachusetts General Hospital</a> </span> <div class="nav__primary__item -search mobile__search-toggle"> <button id="mobile__search-trigger" data-nav="trigger"> <span class="a11y-sr-only">Search</span> </button> </div> <button class="site-nav__toggle" aria-controls="site-navigation" aria-haspopup="true" aria-expanded="false" data-module="nav-toggle"> <span class="a11y-sr-only">Menu</span> </button> </div> <div class="site-header__sub-block" data-header="sub"> <p class="site-header__tagline"> <a href="/default.aspx">Advances in <i>Motion</i></a> </p> </div> <nav aria-label="Main navigation" class="site-nav" id="site-navigation"> <ul class="nav__utility" role="presentation"> <li><a href="/event-education-listing.aspx">Education & Training</a></li> <li><a href="/clinical-trial-listing.aspx">Clinical Trials</a></li> <li><a href="https://www.massgeneral.org/appointments-and-referrals/referral-request">Refer a Patient</a></li> <li><a href="https://www.massgeneral.org/doctors/">Find a Doctor</a></li> <li><a href="https://www.massgeneral.org/research/">Research Institute</a></li> <li><a class="nav__utility--highlight" href="https://advances.massgeneral.org/subscription.aspx">Subscribe</a></li> </ul> <ul class="nav__primary" data-module="navigation" role="presentation"> <li> <a class="nav__primary__trigger -home-link" href="/default.aspx"> <span class="nav__link-wrapper">Advances in Motion Home</span> </a> </li> <li class="nav__primary__item"> <a class="nav__primary__trigger" data-nav="trigger" data-nav-target="nav-specialties" href="/specialty-listing.aspx"> <span class="nav__link-wrapper">Specialties</span></a> <div class="nav__primary__dropdown" data-nav="target" id="nav-specialties"> <ul class="nav__primary__dropdown__links" role="presentation"> <li><a href="https://advances.massgeneral.org/cardiovascular/specialty.aspx?id=1002">Cardiovascular</a></li> <li><a href="https://advances.massgeneral.org/digestive-health/specialty.aspx?id=1007">Digestive Health</a></li> <li><a href="https://advances.massgeneral.org/endocrinology/specialty.aspx?id=1015">Endocrinology</a></li> <li><a href="https://advances.massgeneral.org/geriatrics/specialty.aspx?id=1009">Geriatrics & Palliative Care</a></li> <li><a href="https://advances.massgeneral.org/neuro/specialty.aspx?id=1004">Neuroscience</a></li> <li><a href="https://advances.massgeneral.org/obgyn/specialty.aspx?id=1006">OB/GYN</a></li> <li><a href="https://advances.massgeneral.org/oncology/specialty.aspx?id=1008">Oncology</a></li> <li><a href="https://advances.massgeneral.org/ophthalmology/specialty.aspx?id=1014">Ophthalmology</a></li> <li><a href="https://advances.massgeneral.org/ortho/specialty.aspx?id=1003">Orthopaedics</a></li> <li><a href="https://advances.massgeneral.org/otolaryngology/specialty.aspx?id=1016">Otolaryngology</a></li> <li><a href="https://advances.massgeneral.org/pulmonary/specialty.aspx?id=1012">Pulmonary & Critical Care</a></li> <li><a href="https://advances.massgeneral.org/radiology/specialty.aspx?id=1013">Radiology</a></li> <li><a href="https://advances.massgeneral.org/rheumatology/specialty.aspx?id=1010">Rheumatology, Allergy & Immunology</a></li> <li><a href="https://advances.massgeneral.org/urology/specialty.aspx?id=1005">Urology</a></li> </ul> <p class="fat-link__wrapper u-text-right"> <a class="fat-link -caret" href="/specialty-listing.aspx">View All Specialties</a> </p> </div> </li> <li class="nav__primary__item"> <a class="nav__primary__trigger" data-nav="trigger" data-nav-target="nav-topics" href="/topic-listing.aspx"> <span class="nav__link-wrapper">Topics</span> </a> <div class="nav__primary__dropdown -topics" data-nav="target" id="nav-topics"> <h4>Recently Updated</h4> <div class="nav__primary__dropdown__flex-container" id="topics-scroll-container"> <section class="flex-container__section"> <ul class="flex-container__links -alt" role="presentation"> <li> <a href="/research-and-innovation/topic.aspx?id=1114" target="_blank">Gene and Cell Therapy</a><p>November 5, 2024</p> </li> <li> <a href="/otolaryngology/topic.aspx?id=1113" target="_blank">Hearing Loss</a><p>November 5, 2024</p> </li> <li> <a href="/research-and-innovation/topic.aspx?id=1107" target="_blank">Women's Health</a><p>November 5, 2024</p> </li> <li> <a href="/neuro/topic.aspx?id=1038" target="_blank">Alzheimer's Disease</a><p>October 1, 2024</p> </li> <li> <a href="/neuro/topic.aspx?id=1018" target="_blank">Neurology</a><p>October 1, 2024</p> </li> <li> <a href="/oncology/topic.aspx?id=1059" target="_blank">Colorectal Cancer</a><p>September 11, 2024</p> </li> <li> <a href="/neuro/topic.aspx?id=1031" target="_blank">Depression</a><p>September 10, 2024</p> </li> <li> <a href="/neuro/topic.aspx?id=1017" target="_blank">Psychiatry</a><p>September 10, 2024</p> </li> <li> <a href="/neuro/topic.aspx?id=1029" target="_blank">Addiction</a><p>September 4, 2024</p> </li> <li> <a href="/neuro/topic.aspx?id=1043" target="_blank">Traumatic Brain Injury</a><p>September 2, 2024</p> </li> </ul> </section> <section class="flex-container__section"> <h5>Featured</h5> <ul class="flex-container__links" role="presentation"> <li> <a href="https://advances.massgeneral.org/ortho/topic.aspx?id=1009">Sports Medicine</a> </li> <li> <a href="https://advances.massgeneral.org/research-and-innovation/topic.aspx?id=1056">COVID-19</a> </li> <li> <a href="https://advances.massgeneral.org/neuro/topic.aspx?id=1024">Neurodegenerative Disease</a> </li> <li> <a href="https://advances.massgeneral.org/pulmonary/topic.aspx?id=1058">ARDS</a> </li> <li> <a href="https://advances.massgeneral.org/research-and-innovation/topic.aspx?id=1068">Telemedicine</a> </li> </ul> </section> </div> <p class="fat-link__wrapper u-text-right"> <a class="fat-link -caret" href="/topic-listing.aspx">View All Topics</a> </p> </div> </li> <li> <a class="nav__primary__trigger" href="/multimedia-listing.aspx"> <span class="nav__link-wrapper">Multimedia</span> </a> </li> <li class="nav__primary__item -search"> <a class="nav__primary__trigger" data-nav="trigger" data-nav-search data-nav-target="nav-search" href="/search.aspx"><span class="a11y-sr-only">Search</span></a> <div class="nav__primary__dropdown" data-nav="target" id="nav-search"> <p data-module="label-float"> <label for="site-search"> <span class="nav-search__label--desktop">What are you searching for?</span> <span class="nav-search__label--mobile">Search</span> </label> <input type="search" id="site-search" value=""> <button class="fat-button"><span class="a11y-sr-only">Submit</span></button> </p> </div> </li> </ul> </nav> </header>    <main class="site-main" id="main-content" tabindex="-1"> <div id="panelMainContent"> <article dcrname ="iwDCR0_081549"> <header class="-padding--horizontal" itemscope itemtype="http://schema.org/ScholarlyArticle"> <div class="content-header content-container -width--wide -centered"> <div class="tags"> <ul class="tag__list"> <li class="tag__item"> <a class="tag__link" href="/digestive-health/specialty.aspx?id=1007">Digestive Health</a> </li> <li class="tag__item"> <a class="tag__link" href="/digestive-health/topic.aspx?id=1071">Liver</a> </li> <li class="tag__item"> <a class="tag__link" href="/oncology/specialty.aspx?id=1008">Oncology</a> </li> </ul> </div> <h1 class="content-header__heading" itemprop="name">Case Series: Tofacitinib Is Effective in Treating Refractory Immune Checkpoint Inhibitor Hepatitis</h1> <div class="content-header__metadata"> <p class="content-metadata"> <span class="content-metadata__media -journal">Journal</span> <time class="date" datetime="2024-07-17" itemprop="datePublished">Published on July 17, 2024 </time> </p> <p data-module="share-links"> </p> <p class="citation"> Originally published on <cite itemprop="citation"><a href="https://www.cghjournal.org/article/S1542-3565(23)01043-1/fulltext">Clinical Gastroenterology and Hepatology</a></cite> </p> </div> </div> </header> <div class="-padding--vertical -padding--horizontal"> <div class="layout-columns -width--wide -centered"> <div class="layout-columns__main"> <div class="layout-columns__main__content"> <div class="content-summary"> <h3 class="content-summary__heading">Key findings</h3> <ul> <li>The authors present the first peer-reviewed reports of using a Janus kinase (JAK) inhibitor to treat refractory hepatitis associated with immune checkpoint inhibitors (ICIs)</li> <li>After receiving ipilimumab and nivolumab, three patients with metastatic melanoma developed ICI-hepatitis that was refractory to high-dose glucocorticoids, tacrolimus, and mycophenolate mofetil</li> <li>All patients responded rapidly to tofacitinib 10 mg twice daily administered in the hospital</li> <li>Oncologic outcomes varied, and as JAK signaling is crucial for antitumor responses, research is needed to determine which patients with autoimmune side effects will benefit most from JAK inhibition</li> </ul> </div> <p>Toxicities of immune checkpoint inhibitors (ICIs), including hepatitis, can be dose-limiting or even fatal. Unfortunately, options are limited for patients with ICI-hepatitis who don't respond to systemic glucocorticoids and antimetabolite immunosuppressive medications, the mainstay of treatment.</p><div class="article__signup-container"> <div class="email-signup-inline__container -background--white"> <style> #email-signup-inline { /* 540px */ background-image: url(/assets/raw/email-signup/cardiovascular-sub-callout.jpg); } @media only screen and (-webkit-min-device-pixel-ratio: 2), only screen and (min--moz-device-pixel-ratio: 2), only screen and (-moz-min-device-pixel-ratio: 2), only screen and (-o-min-device-pixel-ratio: 2/1), only screen and (min-device-pixel-ratio: 2), only screen and (min-resolution: 192dpi), only screen and (min-resolution: 2dppx) { #email-signup-inline { /* 1080 width */ background-image: url(/assets/raw/email-signup/cardiovascular-sub-callout.jpg); } } </style> <div class="content-container -width--wide -centered email-signup-inline__wrapper" id="email-signup-inline"> <div class="email-signup-inline__logo"> <img alt="Massachusetts General Hospital building" src="/assets/logos/logo-white.svg"> </div> </div> <div class="email-signup-inline"> <h3 class="email-signup-inline__heading">Subscribe to the latest updates from Digestive Health Advances in Motion</h3> <p class="email-signup-inline__subheading"></p>  <meta http-equiv="Content-Type" content="text/html; charset=utf-8" /> <meta name="referrer" content="no-referrer-when-downgrade">  <script type="text/javascript" data-for="FA__DOMContentLoadedEventDispatch" src="https://massgeneral.tfaforms.net/js/FA__DOMContentLoadedEventDispatcher.js" defer></script> <script type="text/javascript"> document.addEventListener("FA__DOMContentLoaded", function(){ const FORM_TIME_START = Math.floor((new Date).getTime()/1000); let formElement = document.getElementById("tfa_0"); if (null === formElement) { formElement = document.getElementById("0"); } let appendJsTimerElement = function(){ let formTimeDiff = Math.floor((new Date).getTime()/1000) - FORM_TIME_START; let cumulatedTimeElement = document.getElementById("tfa_dbCumulatedTime"); if (null !== cumulatedTimeElement) { let cumulatedTime = parseInt(cumulatedTimeElement.value); if (null !== cumulatedTime && cumulatedTime > 0) { formTimeDiff += cumulatedTime; } } let jsTimeInput = document.createElement("input"); jsTimeInput.setAttribute("type", "hidden"); jsTimeInput.setAttribute("value", formTimeDiff.toString()); jsTimeInput.setAttribute("name", "tfa_dbElapsedJsTime"); jsTimeInput.setAttribute("id", "tfa_dbElapsedJsTime"); jsTimeInput.setAttribute("autocomplete", "off"); if (null !== formElement) { formElement.appendChild(jsTimeInput); } }; if (null !== formElement) { if(formElement.addEventListener){ formElement.addEventListener('submit', appendJsTimerElement, false); } else if(formElement.attachEvent){ formElement.attachEvent('onsubmit', appendJsTimerElement); } } }); </script> <link href="https://massgeneral.tfaforms.net/dist/form-builder/5.0.0/wforms-layout.css?v=20484c23150f9374e828ae7e95c879908749f33b" rel="stylesheet" type="text/css" /> <link href="https://massgeneral.tfaforms.net/uploads/themes/theme-7.css" rel="stylesheet" type="text/css" /> <link href="https://massgeneral.tfaforms.net/dist/form-builder/5.0.0/wforms-jsonly.css?v=20484c23150f9374e828ae7e95c879908749f33b" rel="alternate stylesheet" title="This stylesheet activated by javascript" type="text/css" /> <script type="text/javascript" src="https://massgeneral.tfaforms.net/wForms/3.11/js/wforms.js?v=20484c23150f9374e828ae7e95c879908749f33b"></script> <script type="text/javascript"> wFORMS.behaviors.prefill.skip = false; </script> <script type="text/javascript" src="https://massgeneral.tfaforms.net/wForms/3.11/js/localization-en_US.js?v=20484c23150f9374e828ae7e95c879908749f33b"></script>  <div class="wFormContainer" > <div class=""> <div class="wForm" id="524-WRPR" data-language="en_US" dir="ltr"> <div class="codesection" id="code-524"></div> <form method="post" action="https://massgeneral.tfaforms.net/api_v2/workflow/processor" class="hintsBelow labelsAbove" id="524"> <div class="oneField field-container-D " id="tfa_9-D"> <div aria-live="assertive"> <p class="marketo-signup__error"> Error: Please enter a valid email address. </p> </div> <p class="marketo-signup__input" data-module="label-float"> <label for="email-address"> Email Address </label> <input type="email" id="tfa_9" name="tfa_9" value="" data-marketo="email" > <button class="fat-button" type="submit" data-label="Submit" class="primaryAction" id="submit_button" value="Submit"> <span class="a11y-sr-only">Submit</span> </button> </p> <input type="hidden" id="tfa_10" name="tfa_10" value="Sub_Gastro" class=""><input type="hidden" id="tfa_12" name="tfa_12" value="AiM Sub Box" class=""> </div> <div style="clear:both"></div> <input type="hidden" value="524" name="tfa_dbFormId" id="tfa_dbFormId"> <input type="hidden" value="" name="tfa_dbResponseId" id="tfa_dbResponseId"> <input type="hidden" value="43363a66175b5664ffab7ef336bf1caa" name="tfa_dbControl" id="tfa_dbControl"> <input type="hidden" value="" name="tfa_dbWorkflowSessionUuid" id="tfa_dbWorkflowSessionUuid"> <input type="hidden" value="5" name="tfa_dbVersionId" id="tfa_dbVersionId"> <input type="hidden" value="" name="tfa_switchedoff" id="tfa_switchedoff"> </form> </div> </div> </div> <script id="open-telemetry-script" type="text/javascript" src="https://massgeneral.tfaforms.net/dist/open-telemetry/open-telemetry.152f594b0ae29ae89d4a.js" data-customer-id="1118" data-exporter-url="https://us-east-1-otel.formassembly.com/v1/traces" data-exporter-console="0" ></script> <script src="https://massgeneral.tfaforms.net/api_v2/sst/copy-and-paste"></script> </div> </div> </div> <p><a title="Contributions by Ryan J. Sullivan, MD" href="https://advances.massgeneral.org/contributors/contributor.aspx?id=2040">Ryan J. Sullivan, MD</a>, an oncologist at<span> </span><a class="SWhtmlLink" title="About the Mass General Cancer Center" href="https://www.massgeneral.org/cancer-center" target="_blank" rel="noopener noreferrer">Mass General Cancer Center</a>,<span> </span><a title="Contributions by Michael L. Dougan, MD, PhD" href="https://advances.massgeneral.org/contributors/contributor.aspx?id=1517">Michael L. Dougan, MD, PhD</a>, a physician in the Mass General<span> </span><a title="About the Mass General Division of Gastroenterology" href="https://www.massgeneral.org/medicine/gastroenterology">Division of Gastroenterology</a><span> </span>and director of the GI Center for Cancer Complications at the Mass General Cancer Center, and colleagues are the first to describe three patients with glucocorticoid-refractory ICI-hepatitis who responded well to tofacitinib, an inhibitor of Janus kinase (JAK) 1 and 3.</p> <p>In<span> </span><em><a title="Tofacitinib is Effective in Treating Refractory Immune Checkpoint Inhibitor Hepatitis" href="https://www.cghjournal.org/article/S1542-3565%2823%2901043-1/fulltext" target="_blank" rel="noopener noreferrer">Clinical Gastroenterology and Hepatology</a>,</em><span> </span>they explain that these were the only three patients managed by the Severe Immunotherapy Complications service who were treated with tofacitinib for ICI-hepatitis between August 2022 and September 2023.</p> <h2>Patient 1</h2> <p><strong>Presentation—</strong>A 63-year-old man with metastatic melanoma, previously treated with pembrolizumab, was found to have progressive disease in the liver. One month after beginning ipilimumab and nivolumab, he presented with biopsy-confirmed ICI-hepatitis refractory to high-dose glucocorticoids, mycophenolate mofetil (MMF), and tacrolimus.</p> <p><strong>Response to tofacitinib—</strong>Inpatient treatment with tofacitinib, 10 mg twice daily in combination with continued glucocorticoids, was associated with normalized liver function tests.</p> <p><strong>Oncologic outcomes—</strong>Imaging revealed progression of melanoma in the liver, scalp, and neck 10 months after the last doses of ipilimumab and nivolumab and eight months after the last dose of tofacitinib. The patient restarted nivolumab and was switched to relatlimab without recurrence of hepatitis.</p> <h2>Patient 2</h2> <p><strong>Presentation—</strong>A 46-year-old woman with metastatic melanoma previously treated with pembrolizumab underwent treatment with ipilimumab and nivolumab for progressive disease in the adrenal glands. Three months later, she developed biopsy-confirmed ICI-hepatitis, which was initially glucocorticoid-responsive. However, when prednisone was tapered, her liver function tests worsened, and she was admitted for treatment with tacrolimus and MMF in addition to increased doses of glucocorticoids.</p> <p><strong>Response to tofacitinib—</strong>Because the hepatitis continued to be refractory, tofacitinib 10 mg twice daily was started. The patient's hepatitis resolved rapidly.</p> <p><strong>Oncologic outcomes—</strong>Unfortunately, imaging two months later demonstrated worsening melanoma, and the patient passed away shortly afterward.</p> <h2>Patient 3</h2> <p><strong>Presentation—</strong>A 61-year-old woman with locally advanced melanoma, initially treated with surgical resection and one year of adjuvant nivolumab, was found to have a recurrence in the endometrium, brain, bowel, and multistation lymph nodes. Following hysterectomy and resection and radiation of brain metastases, she received ipilimumab and nivolumab. Three months later, she developed severe ICI-hepatitis refractory to high-dose glucocorticoids, tacrolimus, and MMF.</p> <p><strong>Response to tofacitinib—</strong>Once the patient was started on tofacitinib, 10 mg twice daily, her liver function tests normalized rapidly. Tofacitinib was stopped after six weeks, partly because of a delay in insurance coverage. One week later, the hepatitis returned, although to a lesser degree. The patient was restarted on tofacitinib 10 mg twice daily, again with resolution of hepatitis.</p> <p><strong>Oncologic outcomes—</strong>Subsequent imaging revealed no metastatic disease in the thorax, abdomen, or pelvis but demonstrated progressive disease in the brain. The patient received additional radiation to the brain and then was transitioned to BRAF-targeted therapy.</p> <h2>A Conundrum</h2> <p>JAK inhibitors have also proven effective in managing refractory ICI-colitis and ICI-myocarditis, but JAK1 signaling is crucial for antitumor responses. Research is needed to determine which patients with autoimmune side effects will benefit most from JAK inhibition while maintaining durable antitumor immunity.</p><p class="fat-link__wrapper u-text-right"> <a class="fat-link -caret -large" href="https://www.cghjournal.org/article/S1542-3565(23)01043-1/fulltext">view original journal article <em>Subscription may be required</em></a> </p> <div class="article-attribution" itemscope itemtype="http://schema.org/ScholarlyArticle"> <p class="article-attribution__logo" itemscope itemtype="http://schema.org/Periodical"> <a href="https://www.cghjournal.org/article/S1542-3565(23)01043-1/fulltext"> <span class="a11y-sr-only" itemprop="name">Clinical Gastroenterology and Hepatology</span> </a> </p> <p class="article-attribution__metadata" itemscope itemtype="http://schema.org/PublicationIssue"> <span> Journal Article Published: <time datetime="2023-12-22" itemprop="datePublished">December 22, 2023</time> </span> <span> Dates of Study: <time datetime="2022-08-01" itemprop="startDate">August 1, 2022</time> - <time datetime="2023-09-30" itemprop="endDate">September 30, 2023</time> </span> </p> </div> <p class="cta">Visit the <a href="https://www.massgeneral.org/medicine/gastroenterology">Division of Gastroenterology</a></p> <p class="cta">Refer a patient to the <a href="https://www.massgeneral.org/medicine/gastroenterology/appointments-and-referrals/referral-request">Division of Gastroenterology</a></p> </div> </div> <aside class="layout-columns__sidebar -article__contributors"> <div class="layout-columns__sidebar__content"> <div class="profile-compact__wrapper"> <p class="u-no-margin"> <strong>Contributors</strong> </p> <div class="profile -compact" itemscope itemtype="http://schema.org/Person"> <div class="profile__content"> <h3 class="profile__name" itemprop="name"> <a href="/contributors/contributor.aspx?id=1517" itemprop="url">Michael L. Dougan, MD, PhD ›</a></h3><p class="profile__title" itemprop="jobTitle">Physician, Division of Gastroenterology, Massachusetts General Hospital, Director, GI Center for Cancer Complications, Mass General Cancer Center, Preclinical Education Group Leader, Associate Professor of Medicine, Harvard Medical School </p> </div> <p class="profile__image"> <img alt="Dr. Dougan" itemprop="image" srcset="/assets/images/contributors/michael_dougan_advances.png, /assets/images/contributors/michael_dougan_advances_2x.png 2x" src="/assets/images/contributors/michael_dougan_advances.png"> </p> </div> <div class="profile -compact" itemscope itemtype="http://schema.org/Person"> <div class="profile__content"> <h3 class="profile__name" itemprop="name"> <a href="/contributors/contributor.aspx?id=2040" itemprop="url">Ryan J. Sullivan, MD ›</a></h3><p class="profile__title" itemprop="jobTitle">Oncologist, Massachusetts General Hospital, Associate Professor, Medicine, Harvard Medical School, Associate Professor, Hematology/Oncology, Massachusetts General Hospital</p> </div> <p class="profile__image"> <img alt="Ryan J. Sullivan, MD" itemprop="image" srcset="/assets/images/contributors/ryan_sullivan_advances.png, /assets/images/contributors/ryan_sullivan_advances_2x.png 2x" src="/assets/images/contributors/ryan_sullivan_advances.png"> </p> </div> </div> </div> </aside> <section class="topics-layout -article__related"> <div class="topics-layout__inner"> <div class="topics-layout__sidebar"> <h2 class="section-heading">Related topics</h2> </div> <div class="topics-layout__main"> <ul class="topics-list" data-module="topics-list"> <li><a href="/digestive-health/topic.aspx?id=1071">Liver</a></li> </ul> </div> </div> </section> <section class="-padding--horizontal -padding--vertical -article__related"> <div class="layout-columns -width--wide -centered"> <div class="layout-columns__pod--half"> <div class="content-tease" itemscope itemtype="http://schema.org/ScholarlyArticle"> <p class="content-tease__topic"> <span class="highlight">Related</span> </p> <h3 class="content-tease__heading" itemprop="name"> <a href="/digestive-health/journal.aspx?id=1931" itemprop="url">Immunosuppressive Therapy for IBD Not Linked to Increased Risk of COVID-19</a> </h3> <p itemprop="description"> <p>Kristen E. Burke, MD, MPH, Bharati Kochar, MD and Ashwin N. Ananthakrishnan, MD, MPH, of the Crohn's and Colitis Center, and colleagues collected reassuring data that patients with inflammatory bowel disease can continue using immunosuppressive medication during the COVID-19 pandemic.</p></p> <p class="content-tease__related"> <a href="/digestive-health/topic.aspx?id=1040" itemprop="relatedLink">Bowel Disease</a>, <a href="/research-and-innovation/topic.aspx?id=1056" itemprop="relatedLink">COVID-19</a>, <a href="/digestive-health/specialty.aspx?id=1007" itemprop="relatedLink">Digestive Health</a> </p> <p class="content-metadata"> <span class="content-metadata__media -journal">Journal</span> <time class="date" datetime="2021-05-12" itemprop="datePublished">May 12, 2021</time> </p> </div> </div> <div class="layout-columns__pod--half"> <div class="content-tease" itemscope itemtype="http://schema.org/ScholarlyArticle"> <p class="content-tease__topic"> <span class="highlight">Related</span> </p> <h3 class="content-tease__heading" itemprop="name"> <a href="/digestive-health/journal.aspx?id=2546" itemprop="url">Concurrent Immunosuppressive Therapy With Restart of Checkpoint Inhibitor Reduces Risk of Recurrent Immune-related Enterocolitis</a> </h3> <p itemprop="description"> <p><span>A retrospective study at Massachusetts General Hospital and two other centers found cancer patients who had an immune checkpoint inhibitor restarted after an episode of immune-related enterocolitis had significantly less risk of severe recurrent enterocolitis if they concurrently received infliximab or vedolizumab.</span></p></p> <p class="content-tease__related"> <a href="/digestive-health/topic.aspx?id=1040" itemprop="relatedLink">Bowel Disease</a>, <a href="/digestive-health/specialty.aspx?id=1007" itemprop="relatedLink">Digestive Health</a>, <a href="/oncology/topic.aspx?id=1081" itemprop="relatedLink">Immunotherapy</a>, <a href="/oncology/specialty.aspx?id=1008" itemprop="relatedLink">Oncology</a> </p> <p class="content-metadata"> <span class="content-metadata__media -journal">Journal</span> <time class="date" datetime="2023-11-07" itemprop="datePublished">November 7, 2023</time> </p> </div> </div> </div> </section> </div> </div> </article> </div> </main>  <footer class="site-footer"> <div class="-padding--horizontal"> <nav aria-label="Footer links" class="content-container -width--wide -centered -padding--bottom"> <ul class="footer__nav" role="presentation"> <li> <a href="https://www.massgeneral.org/about">About Mass General</a> </li> <li> <a href="https://www.massgeneral.org/about/support">Giving</a> </li> <li> <a href="https://www.massgeneral.org/news/">News</a> </li> <li> <a href="https://www.massgeneral.org/notices/terms-of-use">Terms of Use</a> </li> <li> <a href="/contact-us.aspx">Contact Us</a> </li> </ul> </nav> <div class="content-container -width--wide -centered -padding--bottom"> <p class="u-text-centered"> <a class="footer__logo" href="http://www.massgeneral.org"> <img alt="MGH" src="/assets/images/logo-color.svg"> <span class="a11y-sr-only">Massachusetts General Hospital</span> </a> </p> <ul class="footer__social" role="presentation"> <li> <a href="https://twitter.com/MassGeneralNews"> <svg width="19" height="15" xmlns=http://www.w3.org/2000/svg viewBox="0 0 18.81 17"><path d="m14.81,0h2.89l-6.3,7.2,7.41,9.8h-5.8l-4.55-5.94-5.2,5.94H.37l6.74-7.7L0,0h5.95l4.11,5.43L14.81,0Zm-1.01,15.28h1.6L5.08,1.63h-1.72l10.43,13.64Z"/></svg> </a> </li> <li> <a href="https://www.facebook.com/massgeneral/"> <svg xmlns="http://www.w3.org/2000/svg" width="9" height="19"><path fill-rule="evenodd" fill="#007EA3" d="M0 6.284h1.929V4.373c0-.84.021-2.139.621-2.943C3.182.578 4.05 0 5.543 0 7.975 0 9 .353 9 .353l-.482 2.911s-.804-.237-1.554-.237-1.421.273-1.421 1.037V6.284h3.075l-.215 2.841h-2.86V19H1.929V9.125H0V6.284z"/></svg> </a> </li> <li> <a href="http://www.youtube.com/user/MassGeneralHospital"> <svg xmlns="http://www.w3.org/2000/svg" width="23" height="17"><path fill-rule="evenodd" fill="#007EA3" d="M22.77 13.325s-.224 1.666-.914 2.399c-.875.963-1.855.968-2.305 1.024-3.218.244-8.051.252-8.051.252s-5.98-.057-7.82-.243c-.512-.101-1.661-.07-2.536-1.033-.69-.733-.914-2.399-.914-2.399S0 11.369 0 9.413V7.579c0-1.956.23-3.912.23-3.912s.224-1.665.914-2.399C2.019.306 2.999.301 3.448.244 6.667 0 11.495 0 11.495 0h.01s4.828 0 8.046.244c.45.057 1.43.062 2.305 1.024.69.734.914 2.399.914 2.399S23 5.623 23 7.579v1.834c0 1.956-.23 3.912-.23 3.912zm-8.519-4.481L9.124 5.246l.001 6.389 5.126-2.791zm-5.127-4v.358l5.887 3.228.328-.179-6.215-3.407z"/></svg> </a> </li> <li> <a href="https://www.linkedin.com/company/massachusetts-general-hospital"> <svg xmlns="http://www.w3.org/2000/svg" width="18" height="18"><path fill-rule="evenodd" fill="#007EA3" d="M14.273 18v-5.846c0-1.396-.027-3.188-1.939-3.188-1.94 0-2.236 1.518-2.236 3.085V18H6.371V5.977h3.575v1.642h.052c.498-.945 1.715-1.941 3.53-1.941 3.775 0 4.472 2.49 4.472 5.728V18h-3.727zM2.164 4.333A2.164 2.164 0 0 1 0 2.166a2.164 2.164 0 1 1 4.327 0 2.166 2.166 0 0 1-2.163 2.167zM4.031 18H.296V5.977h3.735V18z"/></svg> </a> </li> <li> <a href="https://www.doximity.com/pages/hospitals/ma/boston/massachusetts-general-hospital"> <svg xmlns="http://www.w3.org/2000/svg" width="17.583" height="18" viewBox="8.024 95.826 17.583 18"><g fill="#007EA3"><path d="M23.207 104.657c.034-.062.02-.115.02-.168v-5.142c0-.413.173-.586.58-.586h1.278c.34 0 .523.178.523.52v13.803c0 .332-.178.52-.51.52-.45.004-.9.004-1.353 0-.32 0-.513-.197-.513-.52v-1.368c-.062.03-.087.077-.115.12-.442.614-.965 1.138-1.632 1.498-.788.427-1.637.557-2.52.46-1.215-.13-2.232-.657-3.068-1.545-.725-.772-1.152-1.7-1.334-2.736-.207-1.147-.163-2.29.22-3.398.65-1.853 1.925-3.024 3.874-3.36 1.642-.288 3.058.197 4.176 1.464.13.134.245.283.374.437zm-3.216 7.137c1.13-.02 1.978-.47 2.597-1.334.658-.917.812-1.95.605-3.043-.302-1.58-1.59-2.81-3.35-2.698-.96.06-1.766.464-2.3 1.266-.9 1.354-.945 2.793-.182 4.214.557 1.047 1.494 1.566 2.63 1.594zM15.988 95.835c.355-.024.71.004 1.06.042.04.005.078.01.116.024.144.054.226.184.207.333-.023.144-.143.163-.258.173-.624.053-1.23.177-1.82.394-.993.365-1.885.902-2.71 1.555-1.1.864-2.056 1.862-2.81 3.048-.522.82-.93 1.69-1.118 2.65-.02.104-.033.215-.058.32-.024.107-.052.208-.187.227-.13.014-.265-.062-.317-.187-.053-.13-.053-.27-.058-.404-.058-1.244.12-2.45.605-3.6.33-.783.796-1.48 1.368-2.108 1.277-1.412 2.894-2.155 4.76-2.41.203-.03.41-.053.615-.062.202 0 .403.005.605.005zM11.342 105.18c.014-1.512.494-2.842 1.53-3.96.84-.907 1.883-1.44 3.083-1.69.687-.144 1.383-.168 2.08-.1l.104.013c.143.03.24.125.23.24-.015.148-.145.144-.25.163-.173.024-.35.04-.52.072-.916.178-1.727.586-2.48 1.124-.918.658-1.71 1.435-2.343 2.37-.485.716-.854 1.48-.984 2.344-.015.105-.024.23-.178.23-.14 0-.216-.09-.24-.26-.04-.176-.028-.364-.033-.546z"/></g></svg> </a> </li> </ul> <p class="footer__address"> <a href="https://www.google.com/maps/dir/''/55+Fruit+St,+Boston,+MA+02114/@42.3631581,-71.0710274,17z/data=!3m1!4b1!4m8!4m7!1m0!1m5!1m1!1s0x89e370999524529b:0x10e737717f2daf80!2m2!1d-71.0688334!2d42.3631542" itemprop="address" itemscope itemtype="http://schema.org/PostalAddress"> <span itemprop="streetAddress">55 Fruit Street</span> <span itemprop="addressLocality">Boston</span>, <span itemprop="addressRegion">MA</span> <span itemprop="postalCode">02114</span> </a> <span class="footer__phone"> Phone: <a href="tel:6177262000" itemprop="telephone">617-726-2000</a> </span> </p> <p> Copyright © 2007-2024. The General Hospital Corporation. All Rights Reserved. </p> </div> </div> <div class="content-container -padding--horizontal -padding--vertical -background--grey"> <ul class="footer__partners -width--wide -centered" role="presentation"> <li> <a href="https://www.massgeneral.org/education/about"> <img alt="Harvard teaching hospital logo" src="/assets/images/logo-hms.svg" width="170"> </a> </li> <li> <a href="https://www.massgeneralbrigham.org/"> <img alt="Mass General Brigham logo" src="/assets/images/MassGeneralBrigham-grey.svg" width="200"> </a> </li> <li> <a href="https://www.massgeneral.org/about/leadership"> <img alt="Physicians" src="/assets/images/logo-physicians.svg" width="177"> </a> </li> <li> <a href="http://protomag.com/"> <img alt="Proto Magazine Logo" src="/assets/images/logo-proto.svg" width="117"> </a> </li> </ul> </div> </footer> <script src="/assets/scripts/index.js"></script>  </body> </html>