ABSTRACT Introduction Upadacitinib (UPA) is effective for treating luminal Crohn's disease (CD), but data on perianal CD (pCD) remain limited. Methods All consecutive patients with active pCD (primary and/or secondary lesions) treated with UPA across 13 French centres between September 2022 and August 2025 were included in a retrospective cohort study. Clinical remission was defined as absence of fistula drainage (spontaneous or on gentle pressure) and healing of anal ulcerations without initiation of new therapy. Clinical response was defined as ≥ 50% improvement in fistulas and/or ulcerations based on physician assessment. Clinical outcomes were analysed using non‐responder imputation, and magnetic resonance imaging (MRI) outcomes as observed. Results Among the 59 patients included, 43 (73%) had fistulizing pCD and 16 (27%) isolated anal ulcerations. All patients were previously exposed to at least one biologic and 79% of those with fistulizing pCD underwent prior perianal surgery. In patients with fistulizing pCD, clinical remission was achieved in 11/43 (26%) and 11/43 (26%) patients at 6 and 12 months, respectively, clinical response in 21/43 (49%) and 13/43 (30%) patients. At 12 months, MRI response was documented in 9/13 (69%) and MRI remission in 1/13 (8%) patients with fistulizing pCD. Among patients with fistulizing pCD, no factors predicted clinical remission. Among patients with isolated anal ulcerations, complete healing occurred in 5/16 (31%) at 3 months, 4/16 (25%) at 6 months and 4/16 (25%) at 12 months. Conclusion In this real‐world cohort of refractory pCD, UPA achieved clinical remission in one‐quarter of patients at 1 year.
Richard et al. (2026) studied this question.