• Toshihiko Kakiuchi and Masato Yoshiura.
• Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan.
• Medicine (Baltimore). 2022 Nov 11; 101 (45): e31757e31757.

RationaleTofacitinib is an orally administered selective Janus kinase inhibitor. Its efficacy and safety in adults with moderately to severely active ulcerative colitis (UC) have been evaluated in clinical trials; however, its efficacy in pediatric patients with UC is limited.Patient ConcernsA 9-years-old boy was referred to our hospital with chief complaints of diarrhea and bloody stool for 2 months. Colonoscopy revealed total colitis-type UC. His pediatric UC activity index score was 40, indicating moderately active UC.DiagnosisUC.InterventionsVedolizumab, golimumab, and ustekinumab were introduced because of steroid-resistant refractory UC; however, none of these biologics were effective or the effect was short-lived. Therefore, tofacitinib was administered 5 mg twice a day.OutcomesThe patient achieved UC remission after tofacitinib treatment, leading to maintained remission without adverse events.LessonsTo the best of our knowledge, this is the first pediatric case of moderately active UC that was successfully treated with tofacitinib in Japan. Tofacitinib is a safe drug for pediatric patients with moderately active UC. Even in steroid-dependent cases refractory to other biologics, tofacitinib can result in remission induction and maintenance effects. In children and adults, high-dose tofacitinib during induction therapy may be unnecessary to reduce adverse events.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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