"A new study finds that people with moderate to severe ulcerative colitis who havent done well on other treatments may find relief with Xeljanz tofacitinib a drug currently used to treat arthritis.  Ulcerative colitis is a chronic inflammatory bowel disease. It affects about  Americans according to the Crohns and Colitis Foundation CCF. The illness causes inflammation irritation swelling and sores on the lining of the large intestine. Symptoms include diarrhea with blood or pus and abdominal discomfort according to CCF.  There is still a substantial unmet need for new treatments for patients with ulcerative colitis said study lead author Dr. William Sandborn. He is professor of medicine and chief of the division of gastroenterology at the University of California San Diego. Xeljanz targets certain proteins involved in the bodys inflammatory and immune responses that other socalled biologic drugs dont the researchers said.  Treatment with oral tofacitinib is potentially a new treatment option for patients with moderate to severe ulcerative colitis pending review by the U.S. Food and Drug Administration Sandborn said.  The study was funded by Pfizer Inc. the maker of Xeljanz. Sandborn said he has received research grants from the company and served as a consultant for Pfizer. Whether Xeljanz should be used as a first treatment is still not clear said Dr. Arun Swaminath director of the inflammatory bowel disease program at Lenox Hill Hospital in New York City.  Because Xeljanz comes as a pill it could have an advantage for patients Swaminath said. But so far it has only been tried with patients who have not responded to other treatments he said.  How it is used in the real world may be different than how it was used in these studies Swaminath said. I am not going out on a limb and say this should be the first choice because we dont have enough data to say thats the way it should be positioned. The researchers randomly assigned more than  people with ulcerative colitis to one of three phase  trials. The first two trials looked at more than  patients with moderate to severe ulcerative colitis who had failed with conventional treatment or treatment with newer tumor necrosis factor antagonist drugs such as Remicade infliximab. They received Xeljanz or a placebo twice a day for eight weeks.  In the third trial nearly  patients who responded to Xeljanz were assigned to a maintenance dose one group with  milligrams mg and another group with  mg of the drug or placebo for a year.  In the first trial nearly  percent of the patients taking Xeljanz experienced a remission of their condition in eight weeks. That compared to just  percent of patients receiving placebo.  In the second trial almost  percent of those taking Xeljanz had a remission compared with nearly  percent of those taking placebo the researchers found.  In the third trial more than  percent of patients taking  mg of Xeljanz had disease remission after one year. Forty percent of those taking a mg dose of the drug had remission at a year. Only  percent of patients on placebo saw a remission.  However in all of the trials more patients taking Xeljanz suffered from infections such as shingles than those receiving placebo researchers found.  In addition five patients taking Xeljanz developed nonmelanoma skin cancer compared with one patient receiving placebo. Five patients taking the drug experienced heart problems compared with no one on the placebo.  Also compared with placebo Xeljanz was associated with an increase in levels of cholesterol. The report was published May  in the New England Journal of Medicine.  Dr. Sonia Friedman is an associate professor of medicine at Harvard Medical School. Shes also the author of an editorial accompanying the study. Tofacitinib is a promising new class of medical therapy that has efficacy in ulcerative colitis. It is an oral smallmolecule drug that is different from current biologic therapies such as infliximab Remicade adalimumab Humira golimumab Simponi and vedolizumab Entyvio Friedman said. An advantage of Xeljanz is that it is a pill. Other biologic drugs are given by infusion or injection. In addition patients cannot develop antibodies to Xeljanz as they can with other biologic drugs Friedman said. Tofacitinib may be used in the future as rescue therapy from failure of biologics she said. Only future studies will determine whether it can be used as initial therapy for ulcerative colitis and what patients it would help the most.  More information For more information on ulcerative colitis visit the U.S. National Institute of Diabetes and Digestive and Kidney Diseases https SOURCES William Sandborn M.D. professor medicine and chief division of gastroenterology University of California San Diego Sonia Friedman M.D. associate professor medicine Harvard Medical School Boston Arun Swaminath M.D. director inflammatory bowel disease program Lenox Hill Hospital New York City May   New England Journal of Medicine"