Upadacitinib for Acute Severe Ulcerative Colitis

Colectomy rates in acute severe ulcerative colitis (ASUC) continue to be as high as 30% despite advances in treatment.1,2 This emphasizes the need for further therapeutic alternatives. Here, we describe our experience with upadacitinib as rescue therapy for ASUC pending colectomy. Four patients, 2 males, with an age range of 18 to 25 years and UC duration range of 1 to 12 months, were admitted with >10 bloody bowel movements per day lasting 7 to 14 days and an endoscopic Mayo score of 3. All did not respond to in hospital IV steroids and infliximab. In 3 out of 4 patients, 45 mg/day of off-label upadacitinib induced clinical improvements, with a response time range of 4 to 8 days. Three months later, 2 patients were in steroid-free clinical and endoscopic remission (Figure 1), and the third patient maintained clinical response. The fourth patient did not respond and underwent total colectomy (Table 1).