https://orcid.org/0000-0002-2197-4977
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John A Damianos, Olufemi Osikoya, Gregory Brennan, Upadacitinib for Acute Severe Ulcerative Colitis: A Systematic Review, Inflammatory Bowel Diseases, Volume 31, Issue 4, April 2025, Pages 1145–1149, https://doi.org/10.1093/ibd/izae191
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Abstract
Acute severe ulcerative colitis (ASUC) remains a clinical challenge associated with considerable morbidity, including colectomy. Upadacitinib (UPA), a selective Janus kinase (JAK)-1 inhibitor, is approved for moderate-to-severe ulcerative colitis in patients intolerant or not responding to tumor necrosis factor-alpha inhibitors. It has also increasingly been used off-label for ASUC. We performed a systematic review of all available literature on UPA in ASUC. We identified 11 studies, with a pooled total of 55 patients. Most patients experienced rapid and sustained improvement. Colectomy rate at 90 days was 16.3%. Among those who did not get colectomy, 80% were in steroid-free remission at follow-up. The reported adverse events were low, including 2 venous thromboembolic events. Overall, UPA appears to represent a safe and effective therapy for ASUC.
Lay Summary
This systematic review evaluates the efficacy and safety of upadacitinib in treating acute severe ulcerative colitis (ASUC). Results indicate that upadacitinib is a promising option for ASUC patients, with a low colectomy rate and high rates of steroid-free clinical remission.
