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Medscape
11-07-2025
- Health
- Medscape
Good News for Tofacitinib in Recent Study of Acute Severe UC
A head-to-head comparison of the JAK inhibitor drug tofacitinib and chimeric monoclonal antibody infliximab in the treatment of acute severe ulcerative colitis (ASUC) shows that, contrary to concerns, tofacitinib is not associated with worse postoperative complications and in fact may reduce the risk of the need for colectomy. 'Tofacitinib has shown efficacy in managing ASUC, but concerns about postoperative complications have limited its adoption,' reported the authors in research published in Clinical Gastroenterology and Hepatology. 'This study shows that tofacitinib is safe and doesn't impair wound healing or lead to more infections if the patient needs an urgent colectomy, which is unfortunately common in this population,' senior author Jeffrey A. Berinstein, MD, of the Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, Michigan, told Medscape Medical News. Recent treatment advances for UC have provided significant benefits in reducing the severity of symptoms; however, about a quarter of patients go on to experience flares, with fecal urgency, rectal bleeding, and severe abdominal pain of ASUC potentially requiring hospitalization. The standard of care for those patients is rapid induction with intravenous (IV) corticosteroids; however, up to 30% of patients don't respond to those interventions, and even with subsequent treatment of cyclosporine and infliximab helping to reduce the risk for an urgent colectomy, patients often don't respond, and ultimately, up to a third of patients with ASUC end up having to receive a colectomy. While JAK inhibitor therapies, including tofacitinib and upadacitinib, have recently emerged as potentially important treatment options in such cases, showing reductions in the risk for colectomy, concerns about the drugs' downstream biologic effects have given many clinicians reservations about their use. 'Anecdotally, gastroenterologists and surgeons have expressed concern about JAK inhibitors leading to poor wound healing, as well as increasing both intraoperative and postoperative complications, despite limited data to support these claims,' the authors wrote. To better understand those possible risks, first author Charlotte Larson, MD, of the Department of Internal Medicine, Michigan Medicine, and colleagues conducted a multicenter, retrospective, case-control study of 109 patients hospitalized with ASUC at two centers in the US and 14 in France. Of the patients, 41 were treated with tofacitinib and 68 with infliximab prior to colectomy. Among patients treated with tofacitinib, five (12.2%) received infliximab and four (9.8%) received cyclosporine rescue immediately prior to receiving tofacitinib during the index admission. In the infliximab group, one (1.5%) received rescue cyclosporine. In a univariate analysis, the tofacitinib-treated patients showed significantly lower overall rates of postoperative complications than infliximab-treated patients (31.7% vs 64.7%; odds ratio [OR], 0.33; P = .006). The tofacitinib-treated group also had lower rates of serious postoperative complications (12% vs 28.9; OR, 0.20; P = .016). After adjusting for multivariate factors including age, inflammatory burden, nutrition status, 90-day cumulative corticosteroid exposure and open surgery, there was a trend favoring tofacitinib but no statistically significant difference between the two treatments in terms of serious postoperative complications ( P = .061). However, a significantly lower rate of overall postoperative complications with tofacitinib was observed after the adjustment (odds ratio, 0.38; P = .023). Importantly, a subanalysis showed that the 63.4% of tofacitinib-treated patients receiving the standard FDA-approved induction dose of 10 mg twice daily did indeed have significantly lower rates than infliximab-treated patients in terms of serious postoperative complications (OR, .10; P = .031), as well as overall postoperative complications (OR, 0.23; P = .003), whereas neither of the outcomes were significantly improved among the 36.6% of patients who received the higher-intensity thrice-daily tofacitinib dose ( P = .3 and P = .4, respectively). Further complicating the matter, in a previous case-control study that the research team conducted, it was the off-label, 10 mg thrice-daily dose of tofacitinib that performed favorably and was associated with a significantly lower risk for colectomy than the twice-daily dose (hazard ratio 0.28; P = .018); the twice-daily dose was not protective. Berinstein added that a hypothesis for the benefits overall, with either dose, is that tofacitinib's anti-inflammatory properties are key. 'We believe that lowering inflammation as much as possible, with the colon less inflamed, could be providing the benefit in lowering complications rate in surgery,' he explained. Regarding the dosing, 'it's a careful trade-off,' Berinstein added. 'Obviously, we want to avoid the need for a colectomy in the first place, as it is a life-changing surgery, but we don't want to increase the risk of infections.' In other findings, the tofacitinib group had no increased risk for postoperative venous thrombotic embolisms (VTEs), which is important as tofacitinib exposure has previously been associated with an increased risk for VTEs independent of other prothrombotic factors common to patients with ASUC, including decreased ambulation, active inflammation, corticosteroid use, and major colorectal surgery. 'This observed absence of an increased VTE risk may alleviate some of the hypothetical postoperative safety concern attributed to JAK inhibitor therapy in this high-risk population,' the authors wrote. Overall, the results underscore that 'providers should feel comfortable using this medication if they need it and if they think it's most likely to help their patients avoid colectomy,' Berinstein said. 'They should not give pause over concerns of postoperative complications because we didn't show that,' he said. Commenting on the study, Joseph D. Feuerstein, MD, of the Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, noted that, in general, in patients with ASUC who fail on IV steroids, 'the main treatments are infliximab, cyclosporine, or a JAK inhibitor like tofacitinib or upadacitinib, [and] knowing that if someone needs surgery, the complication rates are similar and that pre-operative use is okay is reassuring.' Regarding the protective effect observed with some circumstances, 'I don't put too much weight into that,' he noted. '[One] could speculate that it is somehow related to faster half-life of the drug, and it might not sit around as long,' he said. Feuerstein added that 'the study design being retrospective is a limitation, but this is the best data we have to date.'
Time of India
16-05-2025
- Politics
- Time of India
‘Flushed down the toilet': UC Berkeley student senate rejects Hindu Heritage month; sparks accusations of Hinduphobia, bullying
A video of the meeting, now widely shared on social media platform X, shows one student making a choking gesture and dramatically pretending to suffocate while the resolution was being discussed. (AP) In a decision that has ignited widespread backlash, the Associated Students of the University of California (ASUC) at UC Berkeley voted against a resolution to recognize October as Hindu Heritage Month , prompting outrage from Hindu students , advocacy groups, and civil rights observers. The proposal, Senate Resolution No. 2024/2025-042, was authored by a Caribbean Hindu student and focused solely on celebrating the contributions of Hindus to American society and the UC Berkeley campus. It highlighted Hindu achievements in science, technology, education, and the arts, deliberately avoiding any reference to Indian politics, Hindu nationalism, or current global events. Yet despite its apolitical tone, the resolution faced vehement opposition. Several student senators claimed the measure could be 'used to legitimize Hindu nationalist ideology,' even though those words appear nowhere in the text. The resolution failed to pass, with critics citing vague political concerns while allowing similar heritage recognitions for other groups to proceed without resistance. The Coalition of Hindus of North America (CoHNA) called the vote discriminatory and accused the Senate of engaging in 'Hinduphobia masked as caution.' by Taboola by Taboola Sponsored Links Sponsored Links Promoted Links Promoted Links You May Like 3 Reasons to Plug This Into Your Home Today elecTrick - Save upto 80% on Power Bill Learn More Undo The organization condemned what it described as bullying behavior during the March 5 public meeting and singled out Senator Isha Chander for allegedly steering the discussion toward divisive political rhetoric. CoHNA also expressed solidarity with Senator Justin Taylor, who supported the resolution and, according to observers, faced hostility and mockery from colleagues during the debate. A video of the meeting, now widely shared on social media platform X, shows one student making a choking gesture and dramatically pretending to suffocate while the resolution was being discussed, a moment many interpreted as a disturbing display of disdain for Hindu concerns. CoHNA demanded a formal investigation, an apology to the Hindu student community, and accountability for what it called "public bullying of a fellow senator. " Adding to the controversy, the ASUC temporarily removed the video of the meeting from its Facebook page during student elections. Critics argue this move amounted to political censorship aimed at avoiding scrutiny. 'What are they trying to hide?' CoHNA questioned, calling the deletion 'deeply suspicious' and 'indicative of institutional bias.' The resolution's defeat has reignited concerns about unequal representation of minority faiths on campus. 'All three Abrahamic religions have formal representation at ASUC,' one student speaker said. 'But when it comes to Hindus, our culture is treated as a political threat. The resolution was flushed down the toilet', a crude phrase actually used by one senator during the session. While the ASUC defended its decision as a measure to avoid 'unintended political implications,' Hindu students and supporters argue that the episode reflects a deeper problem: the growing tendency to conflate cultural celebration with controversial geopolitics—especially when it involves Hindu identity. 'It's exhausting,' said one student. 'We just wanted to celebrate our heritage. Instead, we were told to defend politics we don't even identify with.' The debate at UC Berkeley is far from over, as Hindu student organizations, alumni, and advocacy groups now call for transparency, reform, and equal respect for all communities on campus—regardless of the geopolitical baggage others may project onto them.
Time of India
14-05-2025
- Politics
- Time of India
UC Berkeley rejects Hindu Heritage Month: Sparks debate on cultural identity and nationalism
UC Berkeley vote on Hindu Heritage Month raises concerns over cultural bias. (AP Photo) A controversial vote by the Associated Students of the University of California, Berkeley (ASUC) to reject a Hindu Heritage Month proposal has sparked widespread debate over cultural recognition and political sensitivities. A seven-minute video posted on X by @hinduoncampus captures the heated ASUC session, revealing tensions over the proposal's perceived links to Hindu nationalism . Authored by a Caribbean Hindu student, the bill aimed to celebrate Hindu culture but faced opposition for potentially legitimising nationalist ideology in the US. The decision has fuelled accusations of hinduphobia and raised questions about the treatment of Hindu students in American universities. Fears of nationalist ideology Senator Isha Chandar led the opposition, arguing that Hindu Heritage Month could be used to endorse Hindu nationalism. She proposed an alternative resolution celebrating religious diversity across South Asia, Southeast Asia, and the Middle East, avoiding 'internationalist ideology.' Chandar also suggested Hindu Americans have privileges over other South Asian religious groups, framing the bill as potentially exclusionary. Senator Justin Taylor defended the proposal, frustrated by vague references to 'Hindu nationalist statements.' by Taboola by Taboola Sponsored Links Sponsored Links Promoted Links Promoted Links You May Like Villas For Sale in Dubai Might Surprise You Villas in Dubai | Search Ads Get Info Undo He questioned the relevance of linking a Caribbean student's bill to Indian politics, stating, 'People have no clue exactly what they're referring to.' The debate turned personal, with Taylor condemning 'absolutely disgusting' attacks against him. Allegations of bias and bullying The X post and video allege Hindu representatives faced bullying, with subtitles noting students 'ganging up' on the community's advocate. The ASUC president apologised for perceived attacks, but the bill's rejection—despite offers to amend terms like 'Sanatan Dharma' (pronounced 'suh-NAH-tuhn DUH-muh')—intensified claims of discrimination. While other heritage months passed, the Hindu proposal faced unique scrutiny. The Caribbean authorship added confusion, with Taylor asking, 'Why is India being dragged into this?' Subtitles emphasised the bill's apolitical intent, warning against 'discriminatory' outcomes, yet the session exposed deep divisions and mistrust. Debating cultural representation The controversy highlights challenges in recognising Hindu heritage amid global political concerns. The video's subtitles note Hindu Heritage Month's 'complicated history,' citing its occasional ties to 'nationalist rhetoric and Hindu supremacy ideology.' Critics argue the ASUC misunderstood the proposal, conflating cultural pride with political motives. Supporters view the rejection as a missed opportunity for inclusivity. Amplified on X, the debate questions how universities navigate cultural recognition without political bias. The ASUC's decision has sparked calls for better representation of Hindu students and a more nuanced understanding of their identity in Western academia. AI Masterclass for Students. Upskill Young Ones Today!– Join Now
