{
  "abstract": "Background: Data guiding upadacitinib dose de-escalation in ulcerative colitis (UC) are limited. We evaluated factors associated with UC-related complications (UCRC) after upadacitinib was reduced from 45 mg daily.\n\nMethods: This retrospective study included adults with UC at a tertiary center who underwent upadacitinib de-escalation (4/2022-11/2025). The primary outcome was a 12-month composite of UCRC (upadacitinib re-escalation or discontinuation, new systemic steroids, new advanced therapy, hospitalization, or colectomy). Predictors of UCRC after de-escalation were assessed using Cox proportional hazards modeling, including steroid-free clinical remission (SFCR), defined as a stool frequency subscore of 0 or 1 and a rectal bleeding subscore of 0 without systemic steroid use, and biochemical remission, defined as a fecal calprotectin (FC) < 150 μg/g or a C-reactive protein (CRP) < 5 mg/L when FC was unavailable. Optimal CRP and FC cut points were identified via ROC curves.\n\nResults: Among 70 patients, 25 (35.7%) experienced UCRC (median follow-up 56 weeks). Induction duration, prior advanced therapy exposure, and endoscopic severity did not differ significantly between those with and without UCRC. Patients without UCRC were more likely to have achieved SFCR (51.1% vs 20.0%, P=.01) and biochemical remission (53.3% vs 28.0%, P=.04) prior to de-escalation, with lower median CRP (0.8 vs 1.5 mg/L, P=.04) and FC (79.5 vs 208.0 μg/g, P=.03). In multivariable analysis, achieving SFCR (aHR 0.33, 95% CI, 0.12-0.91) and biochemical remission (aHR 0.34, 95% CI, 0.13-0.85) independently predicted lower UCRC risk, and achieving both conferred additional UCAE-free survival benefit. Optimal cut points predicting UCRC were CRP > 12.7 mg/L (sensitivity 40%, specificity 93%) and FC > 58.7 μg/g (sensitivity 100%, specificity 47%).\n\nConclusions: SFCR and biochemical remission prior to upadacitinib de-escalation, but not induction duration, predict lower UCRC risk. Upadacitinib de-escalation should be guided by response assessment rather than a predetermined induction duration.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 8,
  "authors": [
    {
      "name": "Raj M Dalal",
      "orcid": "0009-0002-0994-2662"
    },
    {
      "name": "Sarah Rotondo-Trivette",
      "orcid": "0000-0001-5597-5794"
    },
    {
      "name": "Alec R Mason",
      "orcid": "0000-0003-0376-6522"
    },
    {
      "name": "Lynn Leveille",
      "orcid": "0009-0009-2772-1549"
    },
    {
      "name": "Jianyi Yin",
      "orcid": "0000-0002-1305-5399"
    },
    {
      "name": "Chelsea Missi",
      "orcid": "0009-0007-9658-8417"
    },
    {
      "name": "Moheb Boktor",
      "orcid": "0009-0009-9275-2894"
    },
    {
      "name": "David I Fudman",
      "orcid": "0000-0001-8618-7635"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/300gvyq6c1qdy.bib",
  "cited_by": 0,
  "doi": "10.1093/crocol/otag111",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13730274/?tool=EBI",
  "id": "300gvyq6c1qdy",
  "issns": [
    "2631-827X"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13730274",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "AcademicSubjects/MED00260"
    ],
    [
      "heading",
      "AcademicSubjects/MED00760"
    ],
    [
      "heading",
      "AcademicSubjects/MED00972"
    ],
    [
      "heading",
      "Observations and Research"
    ],
    [
      "openalex",
      "2715|Inflammatory Bowel Disease"
    ]
  ],
  "openalex": "W7225185691",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13730274/pdf/?tool=EBI",
  "pmcid": "PMC13730274",
  "pmid": "42979323",
  "published": "2026-10-01",
  "publisher": "Oxford University Press",
  "ris": "https://research.draconitic.com/paper/300gvyq6c1qdy.ris",
  "sources": [
    {
      "first_seen": "2026-11-04T15:20:47Z",
      "native_id": "PMC:PMC13730274",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13730274"
    },
    {
      "first_seen": "2026-11-07T12:22:52Z",
      "native_id": "PMC13730274",
      "source": "pmc",
      "url": "https://doi.org/10.1093/crocol/otag111"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2715|Inflammatory Bowel Disease",
      "subfield": "general"
    }
  ],
  "title": "Real-world success of de-escalating upadacitinib induction dosing in ulcerative colitis is predicted by steroid-free clinical and biochemical remission, not induction duration",
  "title_text": "Real-world success of de-escalating upadacitinib induction dosing in ulcerative colitis is predicted by steroid-free clinical and biochemical remission, not induction duration",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T12:22:52Z",
  "url": "https://research.draconitic.com/paper/300gvyq6c1qdy",
  "venue": "Crohn's & colitis 360",
  "versions": []
}