Features of the use of upadacitinib in ulcerative colitis and Crohn’s disease in real-world practice: the experience of the city center for inflammatory bowel diseases

Introduction. Upadacitinib is a selective Janus Kinase Inhibitor that has proven to be an effective drug in recent years for the induction and maintenance of remission in inflammatory bowel disease (IBD). The aim of the study was to assess the indications for upadacitinib, the efficacy, tolerability and “survival” of this therapy in real-world practice. Materials and methods. A retrospective cohort study was conducted, which included 17 patients with Crohn’s disease and 7 patients with ulcerative colitis who received upadacitinib therapy at the specialized city IBD clinic in St. Petersburg, Russia in 2023-2024. Study results. The main indications for upadacitinib in IBD were the ineffectiveness of immunosuppressants and the ineffectiveness of biologics. The median duration of upadacitinib therapy was about six months, as a result of treatment, 64.7% of patients with Crohn’s disease and 71.4% of patients with ulcerative colitis achieved endoscopic remission or histological healing, while a time-dependent effect of therapy was noted - the longer the therapy, the more often endoscopic remission or histological healing was achieved. Against the background of therapy, none of the patients had any adverse events that would require the withdrawal of upadacitinib. Upadacitinib therapy was discontinued in only 4 patients with Crohn’s disease and only due to lack of effect, while in all patients with ulcerative colitis, treatment was continued until the end of follow-up. Conclusion. Upadacitinib can be considered as an effective and safe drug for the induction and maintenance of remission in ulcerative colitis and Crohn’s disease, which can be used both as part of any line of therapy and as a “rescue therapy” in case of steroid resistance against the background of a moderate to severe IBD attack.