Upadacitinib Effective for Crohn’s Disease Regardless of Prior Biologic Failure
A post hoc analysis of phase 3 trials published in Clinical Gastroenterology and Hepatology has demonstrated that upadacitinib achieves significantly higher rates of clinical remission and endoscopic response compared with placebo in patients with moderate-to-severe Crohn’s disease (CD), regardless of prior biologic failure.
The study pooled data from 3 trials: 2 induction studies (U-EXCEL and U-EXCEED) and 1 maintenance study (U-ENDURE). A total of 1021 patients participated, of whom 71.8% had prior biologic failure. Induction therapy consisted of upadacitinib 45 mg (UPA45) or placebo for 12 weeks; clinical responders were rerandomized in the maintenance phase to receive placebo, upadacitinib 15 mg, or upadacitinib 30 mg (UPA30) for 52 weeks.
During induction, upadacitinib demonstrated superior rates of clinical remission compared with placebo among patients who had not experienced biologic failure (54.0% vs 28.3%) and those who had experienced failure (42.2% vs 14.1%) and endoscopic response (without failure: 52.0% vs 16.2%; with failure: 35.7% vs 5.3%). In the maintenance phase, UPA30 yielded the greatest benefit, particularly among patients with prior biologic failure (clinical remission: 42.5% vs 8.7%; endoscopic response: 38.9% vs 4.0%). Patients without prior biologic failure had slightly higher absolute response rates and fewer adverse events compared with those with prior biologic failure.
The findings confirm that upadacitinib offers significant clinical and endoscopic benefits in treating moderate-to-severe CD, even in patients with a history of biologic treatment failure. These results highlight this Janus kinase inhibitor as a promising option for achieving and sustaining remission in a challenging patient population.
Reference
Peyrin-Biroulet L, Panaccione R, Louis E, et al. Upadacitinib achieves clinical and endoscopic outcomes in crohn's disease regardless of prior biologic exposure. Clin Gastroenterol Hepatol. 2024;22(10):2096-2106. doi:10.1016/j.cgh.2024.02.026
