Upadacitinib rapidly effective in ulcerative colitis

Treatment with upadacitinib appears to produce improvements in ulcerative colitis (UC) symptoms as early as day 1, as shown in a recent study.

The study was a post hoc analyses of data from two phase III, multicentre induction trials, namely U-ACHIEVE Induction and U-ACCOMPLISH, conducted to establish the earliest time point of efficacy onset.

Researchers looked 14-day diary entry data by patients who received either upadacitinib 45 mg or placebo, taken once daily. They analysed daily improvements in UC symptoms (stool frequency, rectal bleeding, abdominal pain, and bowel urgency), changes in markers (inflammatory markers, high-sensitivity C-reactive protein [hs-CRP], and faecal calprotectin [FCP]), and quality of life (QoL) at weeks 2 and 8.

The analysis included 988 patients, of whom 660 received upadacitinib and 328 received placebo. Patients treated with upadacitinib demonstrated significant improvements vs placebo in all UC symptoms between days 1 and 3, with the improvements persisting through day 14.

Hs-CRP and FCP levels decreased by >50 percent in 75.7 percent and 48.2 percent of patients on upadacitinib, respectively (p<0.001 vs placebo).

Furthermore, upadacitinib treatment led to increased rates of clinical remission/response as measured by Partial Mayo score from week 2 (26.9 percent/59.4 percent vs 4.3 percent/22.3 percent with placebo; p<0.001), as well as substantial improvements in QoL at weeks 2 and 8.

Clinical remission/response at week 8 was strongly associated with early improvement in stool frequency and bowel urgency by day 3 and reductions in hs-CRP and FCP by week 2.