Real-world use affirms benefits of upadacitinib for inflammatory bowel disease

The use of the novel selective JAK-1 inhibitor upadacitinib appears to result in rapid symptom improvements in patients with difficult-to-treat ulcerative colitis (UC) or Crohn’s disease (CD), including those who have prior exposure to tofacitinib, according to real-world data.

In the study, researchers conducted a prospective analysis of clinical outcomes after upadacitinib use in patients with UC and CD using predetermined intervals at weeks 0, 2, 4, and 8. Efficacy was evaluated using the simple clinical colitis activity index (SCCAI) for UC and the Harvey Bradshaw index (HBI) for CD HBI, as well as C-reactive protein (CRP) and faecal calprotectin (FCP). Treatment-related adverse events (AEs) and serious AEs were also documented.

A total of 105 patients were followed for 8 weeks on upadacitinib. Of these, 84 patients, of whom 44 had UC and 40 had CD, had treatment initiated due to active luminal or perianal disease and were included in the analysis. All of them had previously received antitumour necrosis factor therapy, and 89.3 percent had received at least two advanced therapies.

At 4 and 8 weeks of treatment in the UC group, 19/25 (76.0 percent) and 23/27 (85.2 percent) achieved clinical response while 18/26 (69.2 percent) and 22/27 (81.5 percent) achieved clinical remission, respectively. Among those with previous tofacitinib exposure, 7/9 (77.8 percent) achieved clinical remission by 8 weeks.

In the CD group, 13/17 (76.5 percent) showed clinical response and 12/17 (70.6 percent) had clinical remission by 8 weeks. Of those with elevated FCP and CRP, 62 percent and 64 percent saw normalization of levels by week 8, respectively.

The benefits were seen as early as week 2 in both UC and CD groups, with clinical remission rates of 36 percent and 56.3 percent, respectively.

The most common AE was acne, which occurred in 24/105 patients (22.9 percent) overall.