Early Response to Upadacitinib Predicts Long-Term Improvements in Crohn’s Disease
A post hoc analysis of phase 3 clinical trials has demonstrated that achieving early endoscopic response with upadacitinib (UPA) at week 12 of induction is significantly associated with better clinical and quality of life (QoL) outcomes at week 52 in patients with moderate to severe Crohn’s disease (CD), as published in Inflammatory Bowel Diseases.
The study analyzed data from three phase 3 trials, including patients who responded to a 12-week induction regimen of UPA and continued treatment through a 52-week maintenance phase. Researchers compared clinical remission, corticosteroid-free remission, and QoL improvements between patients who achieved endoscopic response, remission, healing, or ulcer-free endoscopy at week 12 and those who did not.
Findings revealed that a significantly greater proportion of patients with early endoscopic response achieved Crohn’s Disease Activity Index (CDAI) remission at week 52 compared to those without an initial response (52.0% vs 34.6%; P ≤ .01). Additionally, 50.0% of early responders achieved corticosteroid-free CDAI remission, compared to 30.9% of nonresponders.
"Early improvement in endoscopic outcomes after UPA induction treatment was associated with long-term meaningful improvements in clinical outcomes and QoL in patients with CD," the study reported.
Patients with early endoscopic response also demonstrated higher rates of Inflammatory Bowel Disease Questionnaire remission (52.6% vs 30.3%) and greater reductions in fatigue (46.7% vs 25.9%), work impairment (47.1% vs 26.5%), and daily activity impairment (53.3% vs 34.1%) (all P < .05).
These findings underscore the importance of early endoscopic assessment in guiding treatment expectations and long-term disease management in patients receiving upadacitinib for Crohn’s disease. Clinicians may consider endoscopic response at week 12 as a key prognostic marker for sustained remission and improved QoL at one year.
Reference
Panés J, Louis E, Bossuyt P, et al. Induction of endoscopic response, remission, and ulcer-free endoscopy with upadacitinib is associated with improved clinical outcomes and quality of life in patients with Crohn's disease. Inflamm Bowel Dis. 2025;31(2):394-403. doi:10.1093/ibd/izae200
