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. 2024 Sep 5;5(4):447-453.
doi: 10.1002/jpr3.12124. eCollection 2024 Nov.

Upadacitinib as salvage therapy in adolescents with acute severe ulcerative colitis refractory to conventional treatments

Andrew Dickerson  1   2 , Jeannie S Huang  1   2 , Laura E Bauman  1   2
Affiliations

Upadacitinib as salvage therapy in adolescents with acute severe ulcerative colitis refractory to conventional treatments

Andrew Dickerson et al. JPGN Rep. .

Abstract

Objectives: Upadacitinib (UPA), a selective Janus kinase-1 inhibitor, has demonstrated efficacy in inducing and maintaining remission in moderate to severe ulcerative colitis (UC) in adults. Current standard management for acute severe ulcerative colitis (ASUC) involves intravenous corticosteroids (IVCS) followed by infliximab (IFX) salvage therapy. Limited data exist on the utility of UPA in ASUC, particularly in adolescents. This case series reports the use of UPA as salvage therapy in hospitalized adolescents experiencing ASUC refractory to IFX.

Methods: We performed a retrospective chart review of hospitalized patients with ASUC who received UPA as salvage therapy after initiation of IVCS and failure of IFX.

Results: Three adolescents were hospitalized with ASUC for which IFX infusion treatments were unsuccessful. Initiation of UPA enabled patients to improve their Pediatric Ulcerative Colitis Activity Index scores to ≤35 and be discharged home. Hospitalization course, complications, and follow-up information are provided.

Conclusion: UPA is a promising short-term salvage therapy in adolescent ASUC cases resistant to conventional treatments. Prospective studies are warranted to elucidate its long-term efficacy and safety in this specific population. These findings provide a novel therapeutic avenue for managing ASUC in adolescents, offering hope for those encountering treatment challenges.

Keywords: Janus kinase inhibitors; acute severe colitis; colectomy; inflammatory bowel disease.

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Conflict of interest statement

Jeannie S. Huang has research funded by Janssen and by Abbvie but not related to this manuscript or upadacitinib. Laura E. Bauman is involved in industry sponsored clinical trials with Gilead and Albireo not related to this manuscript or upadacitinib. All funding is through the institution and is ongoing. The authors declare no conflict of interest.

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