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. 2025 Aug 20:jjaf154.
doi: 10.1093/ecco-jcc/jjaf154. Online ahead of print.

Is 2nd JAKi treatment for UC worth the effort? A retrospective, multi-Centre UK study

Chandni Radia  1   2 , Yaa Danso  3 , Susan Ritchie  4 , Melissa Hale  5 , Alexander T Elford  6   7 , Chirag Patel  8 , Lucy Hicks  9 , Sonia Kalyanji  10 , Chaonan Dong  11 , Katie Yeung  12 , Jie Han Yeo  13 , Mohammed Allah-Ditta  14 , Maria Bishara  15 , Karishma Sethi-Arora  16 , Lushen Pillay  17 , Emma L Johnston  18 , Ruth Rudling  19 , Fiona Rees  20 , Philip Harvey  21 , Hannah Trodden-Mittnacht  22 , Emma Davis  23 , Aileen Fraser  24   25 , Nitish Jivan Sawan  26 , Muhammad Azhar Hussain  27 , Roisin Campbell  28 , Becky George  29 , Megan Rawcliffe  5 , Xin Yi Choon  8 , Krishna Shah  3 , Dania Al-Zarrad  12 , Jennifer Toft  13 , Puneet Chhabra  14 , Nick Burr  19   20 , Alice Hewitt  22 , Rohith Kumar  27 , Sara McCartney  13 , Konstantina Rosiou  22 , Anjan Dhar  4 , Charlie W Lees  6   30 , Christopher A Lamb  11   31 , Ally Speight  11 , Tariq Ahmad  15   32 , Jimmy Limdi  16 , Tim Raine  17 , Alissa Walsh  23 , Rachel Cooney  27 , Paul Harrow  13 , Kamal Patel  10 , Mark Samaan  8 , Polychronis Pavlidis  1 , Alexandra Kent  1 , Christian Selinger  22 , Klaartje Kok  3
Affiliations

Is 2nd JAKi treatment for UC worth the effort? A retrospective, multi-Centre UK study

Chandni Radia et al. J Crohns Colitis. .

Abstract

Background and aims: Janus Kinase inhibitors (JAKi) provide effective treatment for ulcerative colitis (UC), but inadequate response (IR) or intolerance occurs frequently. This study aimed to assess effectiveness of a second JAKi in a real-world UC cohort.

Methods: A retrospective multicentre cohort study encompassing 19 UK hospitals was undertaken. Primary outcome was clinical remission (Simple Clinical Colitis Activity Index/partial Mayo Score ≤ 1) at weeks 8 and 24, based on available assessments. Biochemical (CRP ≤ 5mg/L and faecal calprotectin ≤ 200µg/g) and endoscopic (Ulcerative Colitis Endoscopic Index of Severity/Mayo Endoscopic Subscore ≤ 1) remission were also assessed.

Results: 131 patients with active UC were included. Majority (60%) had exposure to ≥ 3 advanced therapies and 50% required corticosteroids at induction. Clinical remission rates were 59% and 51% at weeks 8 and 24. Biochemical and endoscopic remission rates were 61% and 60% at week 8 and 47% and 32% at week 24. All disease activity parameters significantly reduced by week 8 (p < 0.001). At week 24 no difference was detected in clinical remission rates between those with primary non-response (42%) or secondary loss of response (52%) to their first JAKi (p = 0.518). Clinical remission did not differ between upadacitinib (54%) and filgotinib (36%), p = 0.253. Adverse events occurred in 27% of patients, and serious adverse events in 8%.

Conclusions: In this highly refractory cohort with active UC a second JAKi effectively achieved remission following IR to first JAKi. Type of first JAKi failure did not appear to influence clinical remission. No new safety signals were found.

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