Clinical and Endoscopic Outcomes After Upadacitinib Induction for Ulcerative Colitis: A Multicenter Retrospective Cohort Study

Medical therapies for ulcerative colitis (UC) have recently expanded to include small molecule inhibitors of Janus-kinase (JAK).1–3 Upadacitinib is the newest oral selective JAK1 inhibitor that was approved for the treatment of UC in 2022.2,4 Randomized controlled trials have demonstrated the superiority of upadacitinib to induce remission of UC at 8 weeks compared with placebo.2 However, treatment efficacy observed in clinical trial settings may not reflect real-world clinical practice. Recent real-world studies reported clinical remission rates up to 82% after upadacitinib induction for UC.5,6 However, these studies were limited by small sample sizes.5,6 Additionally, no postinduction endoscopic data have been reported in real-world settings to date. In this multicenter retrospective cohort study, we assessed both clinical and endoscopic outcomes after 8 weeks of upadacitinib induction for UC. This retrospective cohort study included adults who initiated upadacitinib for UC between March 1, 2022 and February 1, 2023, at Brigham and Women’s Hospital (Boston, MA, USA), Massachusetts General Hospital (Boston, MA, USA), and the University of North Carolina at Chapel Hill (Chapel Hill, NC, USA). Electronic health records were manually reviewed, and those who were prescribed upadacitinib primarily for non-UC indications (eg, Crohn’s disease, rheumatoid arthritis) and those with prior colectomies were excluded. Upadacitinib start dates were extracted from gastroenterology and prior authorization documentation.