Intensified Upadacitinib Dosing for Adolescent Patients with Acute Severe Ulcerative Colitis

Area of Science:

• Pediatric Gastroenterology
• Inflammatory Bowel Disease Research
• Pharmacological Interventions

Background:

• Adolescent ulcerative colitis (UC) refractory to anti-tumor necrosis factor (TNF) therapy poses significant challenges, often necessitating hospitalization or surgery.
• Acute severe ulcerative colitis (ASUC) in this population requires effective salvage therapies.
• Upadacitinib shows promise as a colectomy-sparing agent in adults with ASUC.

Purpose of the Study:

• To evaluate the clinical outcomes of intensified rescue upadacitinib dosing in adolescent patients with ASUC.
• To assess the colectomy-sparing potential of upadacitinib in this specific patient group.
• To determine the efficacy of upadacitinib as a salvage therapy for anti-TNF refractory ASUC in adolescents.

Main Methods:

• A case series design was employed to assess clinical outcomes.
• Adolescents admitted with anti-TNF refractory ASUC were treated with an intensified dose of upadacitinib (30 mg twice daily).
• The primary outcome measured was the proportion of patients remaining colectomy-free at the most recent follow-up.

Main Results:

• Five adolescent patients (aged 14-18) with ASUC were included.
• All patients remained colectomy-free during the follow-up period (55-203 days).
• Sixty percent (60%) achieved clinical/biochemical remission without corticosteroids, and three patients received dual advanced therapy with ustekinumab and upadacitinib.

Conclusions:

• Intensified upadacitinib dosing may serve as a potential colectomy-sparing option for adolescents with ASUC.
• This approach is particularly relevant for patients refractory to anti-tumor necrosis factor (TNF) therapy.
• Further research is warranted to confirm these findings in a larger cohort.