Upadacitinib Demonstrates Improved Outcomes Over Tofacitinib in Ulcerative Colitis

A real-world, retrospective cohort study published in The American Journal of Gastroenterology indicates that upadacitinib offers superior long-term outcomes compared to tofacitinib in patients with ulcerative colitis (UC).

Researchers analyzed data from 1,675 patients with UC using the TriNetX multi-institutional database and assessed the risk of hospitalization requiring intravenous steroids and/or colectomy. The primary finding was a lower risk of the composite outcome of intravenous steroid use and/or colectomy at 12 months in the upadacitinib cohort compared to the tofacitinib cohort (adjusted odds ratio [aOR] 0.63, 95% CI 0.44–0.89). “These results highlight upadacitinib’s potential to reduce colectomy rates and disease progression in UC patients,” the authors noted. 

Within 12 months, upadacitinib showed a significant reduction in colectomy risk (aOR 0.46, 95% CI 0.27–0.79) and a trend toward reduced intravenous steroid use (aOR 0.70, 95% CI 0.48–1.02). Sensitivity analyses supported these findings, with the upadacitinib group demonstrating a 36% reduction in the composite outcome risk (aOR 0.64, 95% CI 0.44–0.94) and reductions in both intravenous steroid use (aOR 0.67, 95% CI 0.45–0.99) and colectomy (aOR 0.49, 95% CI 0.26–0.92). 

No significant differences were observed between the two therapies at the 6-month mark, with an aOR of 0.75 (95% CI 0.49–1.09) for the composite outcome. 

“This study utilizing real-world data showed that upadacitinib was associated with improved disease-specific outcomes at 12 months compared with tofacitinib in patients with UC,” the authors concluded. 

Reference
Kochhar GS, Khataniar H, Jairath V, Farraye FA, Desai A. Comparative effectiveness of upadacitinib and tofacitinib in ulcerative colitis: a us propensity-matched cohort study. Am J Gastroenterol. 2024;119(12):2471-2479. doi:10.14309/ajg.0000000000002947