Features of the use of upadacitinib in ulcerative colitis and Crohn’s disease in real-world practice: the experience of the city center for inflammatory bowel diseases

Introduction. Upadacitinib is a selective Janus Kinase Inhibitor that has proven to be an effective drug in recent years for the induction and maintenance of remission in inflammatory bowel disease (IBD). The aim of the study was to assess the indications for upadacitinib, the efficacy, tolerability and “survival” of this therapy in real-world practice. Materials and methods. A retrospective cohort study was conducted, which included 17 patients with Crohn’s disease and 7 patients with ulcerative colitis who received upadacitinib therapy at the specialized city IBD clinic in St. Petersburg, Russia in 2023-2024. Study results. The main indications for upadacitinib in IBD were the ineffectiveness of immunosuppressants and the ineffectiveness of biologics. The median duration of upadacitinib therapy was about six months, as a result of treatment, 64.7% of patients with Crohn’s disease and 71.4% of patients with ulcerative colitis achieved endoscopic remission or histological healing, while a time-dependent effect of therapy was noted - the longer the therapy, the more often endoscopic remission or histological healing was achieved. Against the background of therapy, none of the patients had any adverse events that would require the withdrawal of upadacitinib. Upadacitinib therapy was discontinued in only 4 patients with Crohn’s disease and only due to lack of effect, while in all patients with ulcerative colitis, treatment was continued until the end of follow-up. Conclusion. Upadacitinib can be considered as an effective and safe drug for the induction and maintenance of remission in ulcerative colitis and Crohn’s disease, which can be used both as part of any line of therapy and as a “rescue therapy” in case of steroid resistance against the background of a moderate to severe IBD attack.

inflammatory bowel disease, Crohn’s disease, ulcerative colitis, upadacitinib

1. Ivashkin V.T., Shelygin Yu.A., Belousova E.A. et al. Clinical guidelines. Ulcerative colitis (К51), adults. Coloproctology. 2023;22(1):10-44. (In Russ.) doi: 10.33878/2073-7556-2023-22-1-10-44.@@ Шелыгин Ю.А., Ивашкин В.Т., Белоусова Е.А. и соавт. Клинические рекомендации. Язвенный колит (K51), взрослые. Колопроктология. 2023;22(1):10-44. doi: 10.33878/2073-7556-2023-22-1-10-44.

2. Shelygin Yu.A., Ivashkin V.T., Achkasov S.I. et al. Clinical guidelines. Crohn’s disease (К50), adults. Koloproktologia. 2023;22(3):10-49. (In Russ.) doi: 10.33878/2073-7556-2023-22-3-10-49.@@ Шелыгин Ю.А., Ивашкин В.Т., Ачкасов С.И. и соавт. Клинические рекомендации. Болезнь Крона (К50), взрослые. Колопроктология. 2023;22(3):10-49. doi: 10.33878/2073-7556-2023-22-3-10-49.

3. Uspenskiy Y.P., Ivanov S.V., Fominykh Y.A. et al. Features of the complicated course and extraintestinal manifestations of inflammatory bowel diseases. University Therapeutic Journal. 2023;5(2):68-83. (In Russ.) doi: 10.56871/UTJ.2023.72.18.006.@@ Успенский Ю.П., Иванов С.В., Фоминых Ю.А. и соавт. Особенности осложненного течения и внекишечных проявлений воспалительных заболеваний кишечника. University Therapeutic Journal. 2023;5(2):68-83. doi: 10.56871/UTJ.2023.72.18.006.

4. Torres J., Bonovas S., Doherty G. et al. ECCO guidelines on therapeutics in Crohn’s disease: medical treatment. J Crohns Colitis. 2020;14:4-22. doi: 10.1093/ecco-jcc/jjae091.

5. Raine T., Bonovas S., Burisch J. et al. ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment. Journal of Crohn’s and Colitis. 2022:16(1):2-17. doi: 10.1093/ecco-jcc/jjab178.

6. Olatunji A.O., Maqbool M., Abid M. et al. (September 24, 2024) Safety and Efficacy of Upadacitinib in Crohn’s Disease: An Updated Systematic Review. Cureus. 16(9): e70125. doi: 10.7759/cureus.70125.

7. Mohamed M.F., Beck D., Camp H.S., Othman A.A. Preferential inhibition of JAK1 relative to JAK3 by upadacitinib: exposure-response analyses of ex vivo data from 2 phase 1 clinical trials and comparison to tofacitinib. J Clin Pharmacol. 2020;60:188-97. doi: 10.1002/jcph.1513.

8. Sanmarti R., Corominas H. Upadacitinib for patients with rheumatoid arthritis: a comprehensive review. J Clin Med. 2023;12:1734. doi: 10.3390/jcm12051734.

9. Irani M., Fan C., Glassner K., Abraham B.P. Clinical evaluation of upadacitinib in the treatment of adults with moderately to severely active ulcerative colitis (UC): patient selection and reported outcomes. Clin Exp Gastroenterol. 2023;16:21-8. doi: 10.2147/CEG.S367086.

10. Wodeyar A.M., Pansuriya N., Saeed S. et al.: Upadacitinib in Crohn’s disease: a comprehensive systematic review of efficacy and safety. Cureus. 2023;15: e50657. doi: 10.7759/cureus.50657.

11. Fleischmann R., Mysler E., Bessette L. et al. Long-term safety and efficacy of upadacitinib or adalimumab in patients with rheumatoid arthritis: results through 3 years from the SELECT-COMPARE study. RMD Open. 2022;8: e002012. doi: 10.1136/rmdopen-2021-002012.

12. D’Haens G., Panes J., Louis E. et al. Upadacitinib was efficacious and well-tolerated over 30 months in patients with Crohn’s disease in the CELEST Extension Study. Clin Gastroenterol Hepatol. 2022;20(10):2337-2346.e3. doi: 10.1016/j.cgh.2021.12.030.

13. Uspenskiy Y.P., Petrov S.V., Fominykh Y.A. Clinical features of ulcerative colitis and Crohn’s disease in St. Petersburg: experience of the specialized city clinic for inflammatory bowel diseases treatment. Pharmateca. 2024;1:32-40. (inRuss.) doi: 10.18565/pharmateca.2024.1.32-40.@@ Успенский Ю.П., Петров С.В., Фоминых Ю.А. и соавт. Клинические особенности язвенного колита и болезни Крона в Санкт-Петербурге: опыт работы городского центра воспалительных заболеваний кишечника. Фарматека. 2024;1:32-40. doi: 10.18565/pharmateca.2024.1.32-40.