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To assess how prior biologic exposure affects the efficacy of upadacitinib in inflammatory bowel disease during induction and maintenance phases.

July 31, 2026CureusOpen Access

Impact of Prior Biologic Exposure on Upadacitinib Efficacy in Inflammatory Bowel Disease: A Systematic Review of Randomized Controlled Trials

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To assess how prior biologic exposure affects the efficacy of upadacitinib in inflammatory bowel disease during induction and maintenance phases.
Conducted a systematic review following PRISMA 2020 guidelines.
Included Phase 3 randomized controlled trials assessing upadacitinib in moderate-to-severe ulcerative colitis and Crohn's disease.
Analyzed risk of bias using Cochrane RoB 2 and synthesized findings using the SWiM framework.
Therapeutic response rates were numerically lower in patients with prior biologic exposure, but UPA showed sustained benefits.
In Crohn's disease, risk differences for clinical remission favored UPA significantly over placebo (14.5-33.0 pp).
In ulcerative colitis, UPA demonstrated superior efficacy across primary endpoints compared to placebo.

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Systematic review evaluates upadacitinib efficacy in IBD patients, indicating it remains effective despite prior biologic exposure.

Htun et al. (2026) studied this question.

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