Supplementary Material for: Successful treatment of refractory immune-mediated colitis and duodenitis with tofacitinib

Introduction: Immune-mediated colitis (IMC) is a common and potentially severe immune-related adverse event of immune checkpoint inhibitors (ICIs). Although corticosteroids and biologics are standard treatments, some cases remain refractory. Tofacitinib, a Janus kinase inhibitor, has shown promise in refractory IMC; however, evidence regarding its treatment effects remains limited. Case presentation: Here, we present a case of pembrolizumab-induced IMC and duodenitis refractory to corticosteroids, infliximab, and vedolizumab. The patient was successfully treated after receiving a 30-day course of tofacitinib, which resulted in rapid symptom resolution and mucosal healing. No recurrence of colitis was observed 3 months after treatment cessation. Conclusion: As ICIs are increasingly used, the incidence of refractory IMC and other immune-related toxicities is expected to rise. This case highlights the need for further studies to establish the optimal use of tofacitinib in refractory IMC and duodenitis.引言：免疫介导性结肠炎（immune-mediated colitis, IMC）是免疫检查点抑制剂（immune checkpoint inhibitors, ICIs）常见且具有潜在严重性的免疫相关不良事件。尽管糖皮质激素与生物制剂为标准治疗方案，但部分病例仍呈难治性。托法替布（tofacitinib）作为Janus激酶抑制剂（Janus kinase inhibitor），在难治性IMC中已展现出应用前景，但相关治疗效果的临床证据仍较为有限。 病例报告：本文报告1例由帕博利珠单抗（pembrolizumab）诱导的免疫介导性结肠炎合并十二指肠炎病例，该患者对糖皮质激素、英夫利昔单抗（infliximab）及维多珠单抗（vedolizumab）均应答不佳。患者接受为期30天的托法替布治疗后获得成功救治，症状快速缓解且实现黏膜愈合，停药3个月后未观察到结肠炎复发。 结论：随着免疫检查点抑制剂的临床应用日益广泛，难治性IMC及其他免疫相关毒性的发生率预计将进一步升高。本案例凸显了开展深入研究以明确托法替布在难治性IMC及十二指肠炎中最优使用方案的必要性。