Upadacitinib for refractory ulcerative colitis with primary nonresponse to infliximab and vedolizumab: A case report

Abstract

Background: Many patients with ulcerative colitis (UC) do not respond well to, or tolerate conventional and biological therapies. There is currently no consensus on the treatment of refractory UC. Studies have demonstrated that the selective Janus kinase 1 inhibitor upadacitinib, a small-molecule drug, is effective and safe for treating UC. However, no studies have revealed that upadacitinib is effective in treating refractory UC with primary nonresponse to infliximab and vedolizumab.

Case summary: We report the case of a 44-year-old male patient with a chief complaint of bloody diarrhoea with mucus and pus, in addition to dizziness. The patient had recurrent disease after receiving mesalazine, prednisone, azathioprine, infliximab and vedolizumab over four years. Based on the endoscopic findings and pathological biopsy, the patient was diagnosed with refractory UC. In particular, the patient showed primary nonresponse to infliximab and vedolizumab. Based on the patient's history and recurrent disease, we decided to administer upadacitinib. During hospitalisation, the patient was received upadacitinib under our guidance. Eight weeks after the initiation of upadacitinib treatment, the patient's symptoms and endoscopic findings improved significantly. No notable adverse reactions have been reported to date.

Conclusion: Our case report suggests that upadacitinib may represent a valuable strategy for treating refractory UC with primary nonresponse.

Keywords: Case report; Infliximab; Primary nonresponse; Refractory ulcerative colitis; Upadacitinib; Vedolizumab.

Figure 1

Colonoscopy on November 26, 2019. A: Continuous mucosal erosions can be seen in the junction of the descending colon and sigmoid colon with more pus attached to the surface; B: Persistent mucosal erosion is observed in the sigmoid colon, covered with more pus.

Figure 2

Colonoscopy on February 17, 2021. A: The wrinkled wall of the sigmoid colon is smooth; B: The folded shape of the lower sigmoid colon is regular and the mucosa was smooth; the submucosal vascular texture is clear. No erosion or ulceration is observed in both images.

Figure 3

Colonoscopy on December 17, 2022. A: The mucosa in the sigmoid colon is extensively hyperaemic and oedematous, scattered with multiple irregular shallow ulcers and patchy erosions; B: The hyperaemia and oedema also can be observed in the junction of descending colon and sigmoid colon; and the submucosal vascular texture has disappeared. All the lesions are distributed throughout the mucosa and are covered with a large number of yellow and white secretions.

Figure 4

Colonoscopy on July 10, 2023. A: The mucousa of the descending colon is rough, and the vascular texture is unclear; B: There are extensive cicatricial changes in the sigmoid colon; scattered mucous hyperaemia is observed between the scars. No obvious erosion and ulcers are observed in both figures.