Intensified Upadacitinib Dosing for Adolescent Patients with Acute Severe Ulcerative Colitis
Perseus V. Patel,
Martina Rigmaiden,
Alka Goyal,
Rachel Bensen,
Dorsey Bass,
Jonathan Moses,
Michael J. Rosen,
Ruben J. Colman
Affiliations
Perseus V. Patel
Division of Pediatric Gastroenterology, Department of Pediatrics, Stanford Medicine Children’s Health, Center for IBD and Celiac Disease, Stanford University School of Medicine, Palo Alto, CA 94304, USA
Martina Rigmaiden
Division of Pediatric Gastroenterology, Department of Pediatrics, Stanford Medicine Children’s Health, Center for IBD and Celiac Disease, Stanford University School of Medicine, Palo Alto, CA 94304, USA
Alka Goyal
Division of Pediatric Gastroenterology, Department of Pediatrics, Stanford Medicine Children’s Health, Center for IBD and Celiac Disease, Stanford University School of Medicine, Palo Alto, CA 94304, USA
Rachel Bensen
Division of Pediatric Gastroenterology, Department of Pediatrics, Stanford Medicine Children’s Health, Center for IBD and Celiac Disease, Stanford University School of Medicine, Palo Alto, CA 94304, USA
Dorsey Bass
Division of Pediatric Gastroenterology, Department of Pediatrics, Stanford Medicine Children’s Health, Center for IBD and Celiac Disease, Stanford University School of Medicine, Palo Alto, CA 94304, USA
Jonathan Moses
Division of Pediatric Gastroenterology, Department of Pediatrics, Stanford Medicine Children’s Health, Center for IBD and Celiac Disease, Stanford University School of Medicine, Palo Alto, CA 94304, USA
Michael J. Rosen
Division of Pediatric Gastroenterology, Department of Pediatrics, Stanford Medicine Children’s Health, Center for IBD and Celiac Disease, Stanford University School of Medicine, Palo Alto, CA 94304, USA
Ruben J. Colman
Division of Pediatric Gastroenterology, Department of Pediatrics, Stanford Medicine Children’s Health, Center for IBD and Celiac Disease, Stanford University School of Medicine, Palo Alto, CA 94304, USA
Background/Objectives: In adolescent patients with ulcerative colitis refractory to anti-tumor necrosis factor (TNF) therapy, episodes of acute severe ulcerative colitis (ASUC) require hospitalization or surgery. Upadacitinib can be a potential colectomy-sparing agent in adult ASUC patients receiving intensified dosing. Methods: This case series evaluates clinical outcomes of intensified rescue upadacitinib dosing in adolescent patients with ASUC. We included adolescents admitted with anti-TNF refractory ASUC treated with 30 mg twice daily upadacitinib. The primary outcome was the proportion of patients who remained colectomy-free at the most recent follow-up. Results: Five patients (aged 14–18) exhibited varying responses to upadacitinib; 2 responded rapidly, while 3 had partial response. All the patients remained on upadacitinib and were colectomy-free during follow-up (55–203 days). Three (60%) ultimately received dual advanced therapy with ustekinumab and upadacitinib. At most recent follow-up, 60% were in clinical/biochemical remission without corticosteroids. Conclusions: In select cases, intensified upadacitinib may be a potential colectomy-sparing option for adolescent ASUC patients refractory to anti-TNF therapy.
