Upadacitinib as a rescue therapy for steroid- and infliximab-refractory acute severe ulcerative colitis: short- and long-term effectiveness and safety in a multicenter cohort study
Abstract
Background: Acute severe active ulcerative colitis (ASUC) often requires rescue therapy when standard medical treatment fails. Data on the use of upadacitinib (UPA) as a rescue option after failure of steroids and infliximab (IFX) and on the long-term outcomes of UPA treatment up to 48 weeks, remain scarce.
Methods: We evaluated hospitalized patients with ASUC (Truelove and Witts criteria) who received UPA following the failure of intravenous corticosteroids (IV-CS) and IFX. Outcomes included UPA persistence, clinical remission (CR), partial Mayo score (pMAYO) ≤ 2, clinical response (≥3-point reduction in pMAYO), and colectomy rates over 48 weeks of follow-up.
Results: Fifty patients with ASUC from 11 centers (male, 54%) received UPA treatment following IV-CS/IFX failure. Prior IFX exposure was 86%, and > 50% of the patients had received ≥ 2 biologics. Continuation was 52% overall (week 4, 90%; week 48, 52%). Discontinuation was due to primary nonresponse (42%), secondary loss of response (46%), or other causes (13%). Adverse events related to UPA occurred in 24% of patients and almost all were nonsevere. Stool frequency, rectal bleeding, pMayo score, and C-reactive protein (CRP) improved rapidly by week 1 and were thereafter maintained to week 48. Colectomy occurred in 22% of patients (nearly half of them in week 1). Week 1 CRs were 60%/30% while the week 48 CR rate was 51%. Higher baseline CRP predicted colectomy; no factor affected UPA persistence.
Conclusion: In this multicenter cohort of patients with ASUC who failed IV-CS and IFX rescue, third-line UPA was associated with a low colectomy rate and sustained response up to 1 year, with an acceptable safety profile. UPA may provide sufficient disease control to prevent or delay colectomy, or to serve as a bridge to alternative therapies.
Summary: In this retrospective multicenter cohort (11 centers), 50 patients with severe ulcerative colitis refractory to intravenous corticosteroids and infliximab received upadacitinib. Improved symptoms and C-reactive protein (CRP) levels occurred by week 1 and persisted to week 48; colectomy occurred in 22% and adverse events in 24% of patients.
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BibTeX
@article{unal2026upadacitinib,
title = {{Upadacitinib as a rescue therapy for steroid- and infliximab-refractory acute severe ulcerative colitis: short- and long-term effectiveness and safety in a multicenter cohort study}},
author = {Nalan Gülşen Ünal and Oğuz Kağan Bakkaloğlu and Taylan Kav and Tuğçe Eşkazan and Haluk Tarık Kani and Atilla Akpınar and Pırıl Akıncıoğlu and Gizem Dağcı and İbrahim Şendur and İlker Büyüktorun and Sezgin Barutçu and Güner Kılıç and Göksel Bengi and Bilger Çavuş and Nevin Oruç and Yeşim Özen Alahdab and Özlen Atuğ and Dinç Dinçer and Tarkan Karakan and Ali İbrahim Hatemi and Yusuf Ziya Erzin and Ahmet Tezel and Murat Törüner and Filiz Akyüz and Aykut Ferhat Çelik},
journal = {Inflammatory Bowel Diseases},
year = {2026},
month = jul,
doi = {10.1093/ibd/izag126},
url = {https://doi.org/10.1093/ibd/izag126},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Upadacitinib as a rescue therapy for steroid- and infliximab-refractory acute severe ulcerative colitis: short- and long-term effectiveness and safety in a multicenter cohort study
AU - Nalan Gülşen Ünal
AU - Oğuz Kağan Bakkaloğlu
AU - Taylan Kav
AU - Tuğçe Eşkazan
AU - Haluk Tarık Kani
AU - Atilla Akpınar
AU - Pırıl Akıncıoğlu
AU - Gizem Dağcı
AU - İbrahim Şendur
AU - İlker Büyüktorun
AU - Sezgin Barutçu
AU - Güner Kılıç
AU - Göksel Bengi
AU - Bilger Çavuş
AU - Nevin Oruç
AU - Yeşim Özen Alahdab
AU - Özlen Atuğ
AU - Dinç Dinçer
AU - Tarkan Karakan
AU - Ali İbrahim Hatemi
AU - Yusuf Ziya Erzin
AU - Ahmet Tezel
AU - Murat Törüner
AU - Filiz Akyüz
AU - Aykut Ferhat Çelik
PY - 2026
DA - 2026/07/22
JO - Inflammatory Bowel Diseases
DO - 10.1093/ibd/izag126
UR - https://doi.org/10.1093/ibd/izag126
AB - Background: Acute severe active ulcerative colitis (ASUC) often requires rescue therapy when standard medical treatment fails. Data on the use of upadacitinib (UPA) as a rescue option after failure of steroids and infliximab (IFX) and on the long-term outcomes of UPA treatment up to 48 weeks, remain scarce. Methods: We evaluated hospitalized patients with ASUC (Truelove and Witts criteria) who received UPA following the failure of intravenous corticosteroids (IV-CS) and IFX. Outcomes included UPA persistence, clinical remission (CR), partial Mayo score (pMAYO) ≤ 2, clinical response (≥3-point reduction in pMAYO), and colectomy rates over 48 weeks of follow-up. Results: Fifty patients with ASUC from 11 centers (male, 54%) received UPA treatment following IV-CS/IFX failure. Prior IFX exposure was 86%, and > 50% of the patients had received ≥ 2 biologics. Continuation was 52% overall (week 4, 90%; week 48, 52%). Discontinuation was due to primary nonresponse (42%), secondary loss of response (46%), or other causes (13%). Adverse events related to UPA occurred in 24% of patients and almost all were nonsevere. Stool frequency, rectal bleeding, pMayo score, and C-reactive protein (CRP) improved rapidly by week 1 and were thereafter maintained to week 48. Colectomy occurred in 22% of patients (nearly half of them in week 1). Week 1 CRs were 60%/30% while the week 48 CR rate was 51%. Higher baseline CRP predicted colectomy; no factor affected UPA persistence. Conclusion: In this multicenter cohort of patients with ASUC who failed IV-CS and IFX rescue, third-line UPA was associated with a low colectomy rate and sustained response up to 1 year, with an acceptable safety profile. UPA may provide sufficient disease control to prevent or delay colectomy, or to serve as a bridge to alternative therapies. Summary: In this retrospective multicenter cohort (11 centers), 50 patients with severe ulcerative colitis refractory to intravenous corticosteroids and infliximab received upadacitinib. Improved symptoms and C-reactive protein (CRP) levels occurred by week 1 and persisted to week 48; colectomy occurred in 22% and adverse events in 24% of patients.
SN - 1078-0998
SN - 1536-4844
ER -