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Response to Upadacitinib in Patients with Inflammatory Bowel Disease Previously Treated with Tofacitinib

Tarek Odah1, Christian Karime2, Aakash Desai3

  • 1Division of Gastroenterology and Hepatology, Inflammatory Bowel Disease Center, Mayo Clinic, 4500 San Pablo Rd S., Jacksonville, FL, 32224, USA. Odah.Tarek@mayo.edu.

Digestive Diseases and Sciences
|September 9, 2024
PubMed
Abstract

Insights

Upadacitinib showed significant clinical improvement and reduced inflammation markers in ulcerative colitis patients previously treated with tofacitinib. This JAK inhibitor offers a viable treatment option for patients with prior Janus kinase inhibitor exposure.

Area of Science:

  • Gastroenterology
  • Immunology
  • Pharmacology

Background:

  • Upadacitinib, a Janus kinase (JAK) inhibitor, is approved for ulcerative colitis (UC) and Crohn's disease (CD).
  • Limited data exists on upadacitinib's efficacy after prior treatment with another JAK inhibitor, tofacitinib.
  • This study addresses the gap in understanding upadacitinib's effectiveness in patients previously exposed to tofacitinib.

Purpose of the Study:

  • To evaluate the effectiveness of upadacitinib therapy in patients with UC or CD who previously received tofacitinib.
  • To assess clinical improvement, corticosteroid discontinuation, endoscopic scores, and inflammatory marker changes.
  • To provide insights into treatment sequencing for inflammatory bowel disease.

Main Methods:

  • A multicenter retrospective study involving patients with UC or CD who switched to upadacitinib after tofacitinib treatment.
  • Primary outcome: patient-reported clinical improvement at first follow-up.
  • Secondary outcomes: corticosteroid discontinuation, changes in Mayo Endoscopic Score (MES), and inflammatory markers (fecal calprotectin, C-reactive protein).

Main Results:

  • Eighty-one percent of patients (25/31) experienced clinical improvement on upadacitinib.
  • Eighty percent of corticosteroid-dependent patients (12/15) discontinued systemic corticosteroids.
  • Significant reductions in fecal calprotectin and C-reactive protein were observed, particularly in the UC cohort. UC patients also showed improved MES.

Conclusions:

  • Upadacitinib therapy is associated with clinical improvement in patients with prior tofacitinib exposure.
  • Objective markers of inflammation decreased significantly, especially in ulcerative colitis patients.
  • Upadacitinib represents a potential therapeutic option for patients with inflammatory bowel disease who have previously been treated with tofacitinib.
Keywords:
Crohn’s diseaseInflammatory bowel diseaseTofacitinibUlcerative colitisUpadacitinib

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