Upadacitinib Provides Rapid Symptom Relief in Crohn’s Disease

Upadacitinib (UPA has shown rapid efficacy in improving symptoms of moderately to severely active Crohn’s disease (CD), according to a post hoc analysis of phase 3 clinical trials published in Clinical Gastroenterology and Hepatology.

The study pooled data from 2 induction trials (U-EXCEL and U-EXCEED) and 1maintenance trial (U-ENDURE) to evaluate the impact of UPA 45 mg once daily (UPA45) on stool frequency (SF) and abdominal pain score (APS) over the first 15 days of treatment. A total of 1021 patients were analyzed, including 674 receiving UPA45 and 347 receiving placebo (PBO). 

Results showed that UPA45 led to significant improvements in SF and APS as early as day 5 or 6 of treatment, regardless of prior biologic therapy. By week 2, mean reductions in SF (-2.0) and APS (-0.5) with UPA45 were significantly greater compared with PBO (both P < .001). These improvements were sustained through week 12, with UPA45 showing reductions in SF (-3.0) and APS (-1.0) vs PBO (both P < .001). 

Patients treated with UPA45 achieved daily SF and APS clinical remission earlier (median 13 days) compared with those on PBO (median 32 days). By week 2, higher rates of SF/APS clinical remission (21.1% vs 8.9%) and clinical response (58.8% vs 37.9%) were observed in the UPA45 group (both P ≤ .01). 

The findings highlight UPA45’s potential to provide rapid symptomatic relief for patients with CD, making it a promising option for initial treatment. Further research may focus on long-term outcomes and patient-reported benefits. 

Reference
Colombel JF, Hisamatsu T, Atreya R, et al. Upadacitinib reduces Crohn's disease symptoms within the first week of induction therapy. Clin Gastroenterol Hepatol. 2024;22(8):1668-1677. doi:10.1016/j.cgh.2024.02.027