TBA (25W132)

Real-World Outcomes of Upadacitinib in Inflammatory Bowel Disease in an Irish Centre

Author(s)

Twomey, R., Sugrue, K., Gleeson S., O’Sullivan C., O’Brien L., Carey N., Forde G., Peacock J., Kinsella, C., Moran C., McDonald C., Sheehan D., Buckley M., McCarthy J.

Department(s)/Institutions

Department of Gastroenterology, Mercy University Hospital, Cork

Introduction

Upadacitinib is an oral JAK1 inhibitor licensed for the treatment of moderate-to-severe Inflammatory Bowel Disease (IBD). While clinical trials support its efficacy, real-world data remains limited. Understanding these outcomes is important to guide treatment decisions in clinical practice.

Aims/Background

To evaluate clinical, biochemical, and endoscopic outcomes in a retrospective cohort of patients with IBD initiated on Upadacitinib.

Method

A retrospective review of clinical records and electronic laboratory systems was performed to collect data on patient-reported symptoms, faecal calprotectin levels, and endoscopic findings at baseline, post-induction, and during maintenance therapy.

Results

52 IBD patients (61% male; mean age 38) were evaluated (follow up range 3.5 months to 2.5 years). 69% had previously failed multiple biologic agents. Post-induction, 90% reported symptomatic improvement with 86% showing decreased faecal calprotectin. 37% flared on switch to maintenance dosing (30mg), with a mean time to flare of 20 weeks. 63% were re-commenced on the induction dose (45mg). 83% of those responded. Three patients remain on 45mg long term having flared at 30mg even after a second induction. Reported adverse events included acne (n=14). Data collection is ongoing.

Conclusions

In this real-world cohort, Upadacitinib was associated with high rates of symptomatic and biochemical improvement post-induction. However, over one-third flared on maintenance dosing, most within six months. Reinduction with 45mg was effective in the majority, though a subset required ongoing high-dose therapy. These findings support close monitoring during maintenance and suggest a role for personalised dosing strategies.