Upadacitinib as a rescue therapy for steroid- and infliximab-refractory acute severe ulcerative colitis: short- and long-term effectiveness and safety in a multicenter cohort study

Ünal, Nalan; Bakkaloğlu, Oğuz; KAV, TAYLAN; EŞKAZAN, TUĞÇE; KANİ, HALUK; Akpınar, Atilla; Akıncıoğlu, PIRIL; Dağcı, Gizem; Şendur, İbrahim; Büyüktorun, İlker; Barutçu, Sezgin; Kılıç, Güner; BENGİ, GÖKSEL; Çavuş, Bilger; Oruç, Nevin; Alahdab, Yeşim; Atuğ, Özlen; Dinçer, DİNÇ; KARAKAN, TARKAN; Hatemi, Ali; ERZİN, YUSUF; Tezel, Ahmet; TÖRÜNER, MURAT; Akyüz, Filiz; ÇELİK, AYKUT

doi:10.1093/ibd/izag126

Upadacitinib as a rescue therapy for steroid- and infliximab-refractory acute severe ulcerative colitis: short- and long-term effectiveness and safety in a multicenter cohort study

Ünal N. G., Bakkaloğlu O. K., KAV T., EŞKAZAN T., KANİ H. T., Akpınar A., ...Daha Fazla

Inflammatory Bowel Diseases, cilt.32, sa.11, ss.2085-2094, 2026 (SCI-Expanded, Scopus)

Yayın Türü: Makale / Tam Makale
Cilt numarası: 32 Sayı: 11
Basım Tarihi: 2026
Doi Numarası: 10.1093/ibd/izag126
Dergi Adı: Inflammatory Bowel Diseases
Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE, Health Research Premium Collection (ProQuest)
Sayfa Sayıları: ss.2085-2094
Anahtar Kelimeler: acute severe ulcerative colitis, colectomy, upadacitinib
Akdeniz Üniversitesi Adresli: Evet

Özet

Background: Acute severe active ulcerative colitis (ASUC) often requires rescue therapy when standard medical treatment fails. Data on the use of upadacitinib (UPA) as a rescue option after failure of steroids and infliximab (IFX) and on the long-term outcomes of UPA treatment up to 48 weeks, remain scarce. Methods: We evaluated hospitalized patients with ASUC (Truelove and Witts criteria) who received UPA following the failure of intravenous corticosteroids (IV-CS) and IFX. Outcomes included UPA persistence, clinical remission (CR), partial Mayo score (pMAYO) ≤ 2, clinical response (≥3-point reduction in pMAYO), and colectomy rates over 48 weeks of follow-up. Results: Fifty patients with ASUC from 11 centers (male, 54%) received UPA treatment following IV-CS/IFX failure. Prior IFX exposure was 86%, and > 50% of the patients had received ≥ 2 biologics. Continuation was 52% overall (week 4, 90%; week 48, 52%). Discontinuation was due to primary nonresponse (42%), secondary loss of response (46%), or other causes (13%). Adverse events related to UPA occurred in 24% of patients and almost all were nonsevere. Stool frequency, rectal bleeding, pMayo score, and C-reactive protein (CRP) improved rapidly by week 1 and were thereafter maintained to week 48. Colectomy occurred in 22% of patients (nearly half of them in week 1). Week 1 CRs were 60%/30% while the week 48 CR rate was 51%. Higher baseline CRP predicted colectomy; no factor affected UPA persistence. Conclusion: In this multicenter cohort of patients with ASUC who failed IV-CS and IFX rescue, third-line UPA was associated with a low colectomy rate and sustained response up to 1 year, with an acceptable safety profile. UPA may provide sufficient disease control to prevent or delay colectomy, or to serve as a bridge to alternative therapies. Summary: In this retrospective multicenter cohort (11 centers), 50 patients with severe ulcerative colitis refractory to intravenous corticosteroids and infliximab received upadacitinib. Improved symptoms and C-reactive protein (CRP) levels occurred by week 1 and persisted to week 48; colectomy occurred in 22% and adverse events in 24% of patients.