Fouad Y, Aboelela AS. Lessons from extended induction and practical evidence for improving tofacitinib therapy in ulcerative colitis. World J Gastroenterol 2026; 32(9): 115785 [DOI: 10.3748/wjg.v32.i9.115785]
Corresponding Author of This Article
Yasser Fouad, MD, Doctor, Department of Gastroenterology and Endemic Medicine, Faculty of Medicine, Minia University, El Horryia Street, Minia 19111, Egypt. yasserfouad10@yahoo.com
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Gastroenterology & Hepatology
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Editorial
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Mar 7, 2026 (publication date) through Mar 2, 2026
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Publication Name
World Journal of Gastroenterology
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1007-9327
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Fouad Y, Aboelela AS. Lessons from extended induction and practical evidence for improving tofacitinib therapy in ulcerative colitis. World J Gastroenterol 2026; 32(9): 115785 [DOI: 10.3748/wjg.v32.i9.115785]
World J Gastroenterol. Mar 7, 2026; 32(9): 115785 Published online Mar 7, 2026. doi: 10.3748/wjg.v32.i9.115785
Lessons from extended induction and practical evidence for improving tofacitinib therapy in ulcerative colitis
Yasser Fouad, Ahmed S Aboelela
Yasser Fouad, Department of Gastroenterology and Endemic Medicine, Faculty of Medicine, Minia University, Minia 19111, Egypt
Ahmed S Aboelela, Department of Gastroenterology and Endemic Medicine, Faculty of Medicine, Galala University, Galala 17234, Egypt
Author contributions: Both authors participated in designing, writing and revising the editorial.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Corresponding author: Yasser Fouad, MD, Doctor, Department of Gastroenterology and Endemic Medicine, Faculty of Medicine, Minia University, El Horryia Street, Minia 19111, Egypt. yasserfouad10@yahoo.com
Received: October 25, 2025 Revised: December 2, 2025 Accepted: January 4, 2026 Published online: March 7, 2026 Processing time: 125 Days and 16.2 Hours
Abstract
With the introduction of Janus kinase inhibitors like tofacitinib, the treatment landscape for ulcerative colitis (UC) is changing quickly. Response heterogeneity is still a significant clinical challenge in spite of its quick onset and oral convenience. Extending tofacitinib induction beyond the standard eight weeks can produce significant benefits in a subset of patients without sacrificing safety, according to evidence from pivotal trials and real-world studies. We review recent real-world evidence, highlight lessons learnt from extended induction therapy, and present a practical framework to help guide tailored treatment decisions in this editorial. After 16 weeks of prolonged induction, more than half of patients with moderate-to-severe UC experienced remission, with durable persistence and favorable safety, according to a multicenter 52-week real-world study published in this issue of the World Journal of Gastroenterology. Crucially, outcomes and maintenance dosing were impacted by modifiable factors like smoking and biologic exposure. Mechanistic findings support a response-guided rather than fixed-duration induction paradigm by indicating that immune kinetics, mucosal healing rates, and previous biologic exposure may account for delayed responses. An effective, patient-centered strategy that could maximize tofacitinib’s therapeutic potential and assist in guiding refractory UC patients towards long-term remission is extended induction.
Core Tip: Partial or delayed responders with ulcerative colitis can be saved by extending tofacitinib induction from 8 weeks to 16 weeks without raising safety concerns. Evidence from the real world shows that this approach, especially in patients with biologic experience, results in higher remission rates and long-lasting drug persistence. Instead of a strict 8-week limit, a structured, response-guided algorithm enables clinicians to address modifiable risk factors like smoking, maximize long-term outcomes, and customize therapy. Now, extended induction ought to be seen as a logical, scientifically supported part of customized tofacitinib treatment.
