Upadacitinib therapy during hospitalisation for moderate to severe ulcerative colitis in patients previously treated with infliximab: a UK tertiary care centre experience and literature review
File(s)
Published version (online first)
Author(s)
Manti, Magdalini
Kamperidis, Nikolaos
Misra, ravi
Toskas, Alex
Arebi, Naila
Type
Journal Article
Abstract
Objective: A plethora of patients diagnosed with ulcerative colitis (UC) will develop an episode of moderate to severe UC flare during the disease course, which may require hospitalisation. Rescue therapy after intravenous corticosteroid failure traditionally includes
infliximab (IFX) or ciclosporin; however, many patients admitted with a moderate to severe UC flare have prior IFX exposure, limiting its utility. Janus kinase inhibitors (JAKi), particularly upadacitinib, have shown promise in observational studies, but data remain limited.
Design/Methods: We conducted a retrospective, single-centre observational study of adults admitted with moderate to severe ulcerative colitis flare and previously exposed to IFX who received upadacitinib 45 mg daily as inpatients between January 2023 and June 2025. The primary outcomes were colectomy-free survival at week 12 and clinical remission at discharge, defined by a simple clinical colitis activity index (SCCAI) score ≤2. Secondary outcomes included clinical response, biochemical remission evaluated by faecal calprotectin (FCP) and C-reactive protein (CRP), endoscopic response, treatment persistence, adverse events, and colectomy rates up to 12 months.
Results: We recruited 24 patients. The mean age was 44.3 years (±14.5) with a median disease duration of 5 years (IQR 2.6–14.8). Colectomy-free survival at week 12 was 91.7%, with colectomies performed on days 8 and 16 post-initiation. Among the 12 patients with 12-month follow-up, no further colectomies occurred. SCCAI improved from a median value of 9 on admission to 2 at week 12. 9 out of 22 patients (41%) on upadacitinib achieved biochemical remission at week 12 with FCP below 150 ug/g and CRP below 5 mg/L. The ulcerative colitis endoscopic index of severity (UCEIS) was also evaluated with 4 patients achieving endoscopic response (66.7%) at week 12. No major adverse events occurred, including thromboembolic events and malignancies; minor adverse events included acne,
flu-like symptoms, and transient abnormal liver function tests.
Conclusion: Upadacitinib shows promise as a potential rescue option in moderate to severe UC among patients previously exposed to IFX. Randomised controlled trials are needed to confirm its efficacy and safety in both IFX-naïve and previously exposed populations.
infliximab (IFX) or ciclosporin; however, many patients admitted with a moderate to severe UC flare have prior IFX exposure, limiting its utility. Janus kinase inhibitors (JAKi), particularly upadacitinib, have shown promise in observational studies, but data remain limited.
Design/Methods: We conducted a retrospective, single-centre observational study of adults admitted with moderate to severe ulcerative colitis flare and previously exposed to IFX who received upadacitinib 45 mg daily as inpatients between January 2023 and June 2025. The primary outcomes were colectomy-free survival at week 12 and clinical remission at discharge, defined by a simple clinical colitis activity index (SCCAI) score ≤2. Secondary outcomes included clinical response, biochemical remission evaluated by faecal calprotectin (FCP) and C-reactive protein (CRP), endoscopic response, treatment persistence, adverse events, and colectomy rates up to 12 months.
Results: We recruited 24 patients. The mean age was 44.3 years (±14.5) with a median disease duration of 5 years (IQR 2.6–14.8). Colectomy-free survival at week 12 was 91.7%, with colectomies performed on days 8 and 16 post-initiation. Among the 12 patients with 12-month follow-up, no further colectomies occurred. SCCAI improved from a median value of 9 on admission to 2 at week 12. 9 out of 22 patients (41%) on upadacitinib achieved biochemical remission at week 12 with FCP below 150 ug/g and CRP below 5 mg/L. The ulcerative colitis endoscopic index of severity (UCEIS) was also evaluated with 4 patients achieving endoscopic response (66.7%) at week 12. No major adverse events occurred, including thromboembolic events and malignancies; minor adverse events included acne,
flu-like symptoms, and transient abnormal liver function tests.
Conclusion: Upadacitinib shows promise as a potential rescue option in moderate to severe UC among patients previously exposed to IFX. Randomised controlled trials are needed to confirm its efficacy and safety in both IFX-naïve and previously exposed populations.
Date Issued
2025-12-24
Date Acceptance
2025-11-18
Citation
Frontline Gastroenterology, 2025
ISSN
2041-4137
Publisher
BMJ Publishing Group
Journal / Book Title
Frontline Gastroenterology
Copyright Statement
© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/.
License URL
Identifier
10.1136/flgastro-2025-103412
Publication Status
Published online
Date Publish Online
2025-12-24