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Real-World Comparative Effectiveness and Safety of Filgotinib and Upadacitinib for Ulcerative Colitis: A Multicentre

Akira Nogami1,2, Kunio Asonuma1, Shinji Okabayashi3

  • 1Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.

United European Gastroenterology Journal
|November 13, 2024
PubMed
Abstract

Insights

Upadacitinib (UPA) showed higher short-term effectiveness for ulcerative colitis (UC) compared to filgotinib (FIL), including in patients previously treated with tofacitinib (TOF). However, UPA was associated with more adverse events than FIL.

Area of Science:

  • Gastroenterology
  • Immunology
  • Pharmacology

Background:

  • Janus kinase (JAK) inhibitors, filgotinib (FIL) and upadacitinib (UPA), are emerging treatments for ulcerative colitis (UC).
  • Comparative data for FIL and UPA, especially in patients with prior tofacitinib (TOF) exposure, are limited.

Purpose of the Study:

  • To compare the efficacy and safety of FIL versus UPA in UC patients.
  • To evaluate treatment outcomes in UC patients with prior TOF exposure.

Main Methods:

  • A multicentre retrospective cohort study comparing FIL and UPA in UC patients.
  • Co-primary outcomes: clinical response and remission at week 8.
  • Secondary outcomes: treatment persistence and adverse events (AEs).
  • Used modified Poisson and Cox regression with propensity score matching for analysis.

Main Results:

  • Upadacitinib (UPA) demonstrated significantly higher rates of clinical response (aRR 1.40) and remission (aRR 1.54) at week 8 compared to filgotinib (FIL).
  • These findings were consistent across subgroups, including those with prior TOF or biologic exposure.
  • Adverse events were more frequent with UPA (45.7%) than FIL (24.5%).

Conclusions:

  • Upadacitinib (UPA) offers superior short-term effectiveness for ulcerative colitis (UC) compared to filgotinib (FIL).
  • Increased adverse event incidence was observed with UPA treatment.
  • Treatment persistence did not differ significantly between the two JAK inhibitors.
Keywords:
Janus kinase inhibitorsadvanced therapyfilgotinibinflammatory bowel diseasetofacitinibulcerative colitisupadacitinib

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