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Review
. 2023 Mar 11:16:17562848231158235.
doi: 10.1177/17562848231158235. eCollection 2023.

Update on the role of upadacitinib in the treatment of adults with moderately to severely active ulcerative colitis

Kenneth Ernest-Suarez  1 , Remo Panaccione  2
Affiliations
Review

Update on the role of upadacitinib in the treatment of adults with moderately to severely active ulcerative colitis

Kenneth Ernest-Suarez et al. Therap Adv Gastroenterol. .

Abstract

With further knowledge of the pathogenesis of inflammatory bowel disease, small oral molecules have become available, including the Janus kinase (JAK) inhibitors. Upadacitinib (UPA) is a selective JAK1 inhibitor and has become the newest drug in this class, with recent approval for the management of moderate-to-severe ulcerative colitis. The large phase III program (including the U-ACHIEVE and U-ACCOMPLISH parallel induction trials and the U-ACHIEVE Maintenance trial) demonstrated superiority over placebo, for all primary and secondary endpoints including key clinical, endoscopic, and histological outcomes utilizing 45 mg orally (po) once daily (OD) during induction and either 30 mg or 15 mg po OD in maintenance. From a safety perspective, UPA has proven to be a safe and well-tolerated medication across immune-mediated diseases with manageable adverse risks such as an increase in herpes zoster. Proper discussion and patient profiling are essential when positioning UPA, considering efficacy and potential risks associated with this highly effective medication.

Keywords: JAK inhibitor; inflammatory bowel disease; small oral molecules; ulcerative colitis; upadacitinib.

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Conflict of interest statement

KES: Consultant, advisor, and speaker for Abbvie, AstraZeneca, Ferring, Janssen, Pfizer, Sandoz. RP: Consultant, advisor, and speaker for Abbott, AbbVie, Alimentiv (formerly Robarts), Amgen, Arena Pharmaceuticals, AstraZeneca, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Celltrion, Cosmos Pharmaceuticals, Eisai, Elan, Eli Lilly, Ferring, Galapagos, Fresenius Kabi, Genentech, Gilead Sciences, Glaxo-Smith Kline, JAMP Bio, Janssen, Merck, Mylan, Novartis, Oppilan Pharma, Organon, Pandion Pharma, Pendopharm, Pfizer, Progenity, Protagonist Therapeutics, Roche, Sandoz, Satisfai Health, Shire, Sublimity Therapeutics, Takeda Pharmaceuticals, Theravance Biopharma, Trellus, Viatris, UCB. Remo Panaccione and Kenneth Suarez have served as consultants and speakers to Abbvie. Remo Panaccione was the senior investigator in the upadacitinib development program.

Figures

Figure 1.
Figure 1.
JAK/STAT pathway: activation and inhibition. JAK, Janus kinase; STAT, signal transducer and activator of transcription.
See this image and copyright information in PMC

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