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Real-World Comparative Efficacy and Safety of Upadacitinib, Tofacitinib, and Filgotinib in Patients With Ulcerative

Fraz Ahmad1, Tausif Hussain1, Chamith H Gunaratne2

  • 1Gastroenterology and Hepatology, Royal Blackburn Hospital, Blackburn, GBR.

Cureus
|February 24, 2026
PubMed

Insights

Upadacitinib, tofacitinib, and filgotinib show effectiveness in treating ulcerative colitis (UC) patients. Upadacitinib demonstrated the highest biochemical response, with all JAK inhibitors exhibiting a favorable safety profile in this real-world study.

Area of Science:

  • Gastroenterology
  • Pharmacology
  • Immunology

Background:

  • Janus kinase (JAK) inhibitors are emerging oral therapies for moderate to severe ulcerative colitis (UC).
  • Real-world data on the comparative efficacy and safety of upadacitinib, tofacitinib, and filgotinib in UC is limited.
  • Understanding comparative effectiveness is crucial for optimizing UC treatment strategies.

Purpose of the Study:

  • To evaluate the comparative real-world efficacy and safety of upadacitinib, tofacitinib, and filgotinib in patients with ulcerative colitis (UC).
  • To assess biochemical and endoscopic responses to these JAK inhibitors.
  • To identify potential differences in safety profiles among the three agents.

Main Methods:

  • Retrospective analysis of 52 patients with mild to severe UC treated with upadacitinib, tofacitinib, or filgotinib.
  • Evaluation of inflammatory biomarkers, including faecal calprotectin (FCP) reduction.
  • Assessment of endoscopic inflammation and adverse events.

Main Results:

  • Significant improvements in inflammatory biomarkers were observed across all JAK inhibitor groups.
  • High-grade biochemical response (≥75% FCP reduction or normalization) was highest with upadacitinib (86.4%), followed by tofacitinib (62.5%) and filgotinib (50%).
  • Endoscopic improvements were noted, particularly with upadacitinib and tofacitinib. Hyperlipidemia was the most common adverse event; no serious opportunistic infections or thromboembolic events were recorded.

Conclusions:

  • Upadacitinib, tofacitinib, and filgotinib are effective oral therapies for UC in real-world clinical practice.
  • Upadacitinib showed the strongest biochemical response in this treatment-experienced cohort.
  • Further prospective studies are needed to confirm long-term efficacy and safety.
Keywords:
gastrointestinalinflammatory bowel diseasejanus kinase inhibitorsreal-world studytofacitinibulcerative colitisupadacitinib

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