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Comparative effectiveness of low versus high dose upadacitinib as maintenance treatment in patients with ulcerative colitis: a real-world cohort study from the United States
Journal article   Open access   Peer reviewed

Comparative effectiveness of low versus high dose upadacitinib as maintenance treatment in patients with ulcerative colitis: a real-world cohort study from the United States

Priya Sehgal, Gursimran S Kochhar, Harpreet Kaur, Himsikhar Khataniar, Raina Shivashankar, James D Lewis and Aakash Desai
Crohn's & colitis 360, v 8(2), otag028
08 May 2026
DOI: https://doi.org/10.1093/crocol/otag028
PMID: 42137135
Featured in Collection :   Drexel's Newest Publications
url
https://doi.org/10.1093/crocol/otag028View
Published, Version of Record (VoR) Open

Abstract

Clinical outcomes Colorectal surgery Drug dosages Cohort Analysis Inflammatory Bowel Disease Steroids
Background There is limited real-word data comparing efficacy of low dose upadacitinib (UPA) to high dose UPA as maintenance therapy for ulcerative colitis (UC). Methods This was a retrospective cohort study utilizing the U.S. Collaborative Network in adults ≥18 years old with UC who initiated UPA 15 mg compared to 30 mg for maintenance therapy between April 2022 and December 2023. The primary outcome was a composite of intravenous steroid use, oral steroid use, or colectomy from 12 to 60 weeks from the index UPA prescription. Propensity score matching (PSM) was performed for demographics, co-morbid conditions, laboratory, and IBD medication history. Cox proportional hazard model was used to identify predictors of failure. Results Among 1110 patients on UPA maintenance therapy, 361 (32.5%) were on 15 mg and 749 (67.5%) were on 30 mg. After PSM, there was no difference in the composite outcome of steroid use or colectomy between the 15-mg UPA cohort versus 30 mg cohort (35.3% vs 35.6%; aHR 0.95, 0.71-1.24, P = .8). There was no difference in IV steroid use, oral steroid use or change in therapy between the two cohorts. There was no difference in the proportion of patients who achieved a fecal calprotectin of <250 μg/g (55.8% vs 63.5%, P = .33). Recent oral or IV steroid use and rheumatoid arthritis were associated with failure of both 15 mg and 30 mg UPA. Conclusion Our study indicates that 15 mg UPA shows similar efficacy as 30 mg UPA for maintenance treatment in a subset of patients with UC.Lay Summary This study aimed to compare maintenance dosing options for upadacitinib, 15 mg versus 30 mg, for patients with UC. This study found no difference between 15 mg versus 30 mg with regards to steroid use or colectomy outcomes.

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