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Updated: May 11, 2026

Scaled-Up Preparation of an Intermediate of Upatinib, ACT051-3
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Scaled-Up Preparation of an Intermediate of Upatinib, ACT051-3

Published on: April 7, 2023

Comparative Effectiveness and Safety of Tofacitinib, Filgotinib, and Upadacitinib in Ulcerative Colitis: A

Antonio Tursi1,2, Andrea Pasta3, Walter Elisei4

  • 1Territorial Gastroenterology Service, ASL BAT, Andria, Italy.

Advances in Therapy
|May 9, 2026
PubMed
Abstract

Insights

Upadacitinib demonstrated superior clinical remission rates compared to tofacitinib and filgotinib in ulcerative colitis patients. While all Janus kinase inhibitors (JAKis) were effective, differences in safety profiles suggest personalized treatment approaches for ulcerative colitis.

Area of Science:

  • Gastroenterology
  • Immunology
  • Pharmacology

Background:

  • Janus kinase inhibitors (JAKis) like tofacitinib, filgotinib, and upadacitinib are options for ulcerative colitis (UC) refractory to advanced therapies.
  • Comparative effectiveness of these JAKis in real-world clinical practice for UC is not well-established.

Purpose of the Study:

  • To compare the effectiveness and safety of tofacitinib, filgotinib, and upadacitinib in adult patients with ulcerative colitis.
  • To evaluate clinical remission, steroid-free remission, biochemical remission, and endoscopic remission rates at various time points.

Main Methods:

  • Multicenter retrospective study of adult UC patients initiating one of the three JAKis.
  • Inverse probability of treatment weighting (IPTW) used to control for baseline differences.
  • Time-to-event and longitudinal analyses performed to assess outcomes.

Main Results:

  • Upadacitinib showed higher probabilities of clinical remission at weeks 8, 24, and 52 compared to tofacitinib and filgotinib (p<0.001 at weeks 8 and 24).
  • Steroid-free clinical remission and endoscopic remission rates also favored upadacitinib at week 52 (p=0.039).
  • Tofacitinib had more adverse events, particularly infections, while filgotinib had fewer non-serious events; serious adverse events were similar across groups.

Conclusions:

  • All three JAKis are effective for ulcerative colitis, with upadacitinib demonstrating superior remission rates.
  • Tofacitinib and filgotinib showed differences primarily in their safety profiles.
  • Individualized drug selection is recommended based on patient efficacy needs and specific risks.
Keywords:
FilgotinibReal lifeRemissionSafetyTofacitinibUlcerative colitisUpadacitinib

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