Upadacitinib Shows Promise for Refractory Lymphocytic Colitis

Upadacitinib may offer a new treatment avenue for refractory lymphocytic colitis, according to an abstract presented at the Advances in Inflammatory Bowel Diseases annual meeting.

The study involved a 54-year-old woman with lymphocytic colitis, characterized by chronic, nonbloody diarrhea and abdominal pain. Despite treatment with first-line budesonide and multiple second-line therapies—including mesalamine, azathioprine, and biologics such as adalimumab and vedolizumab—her symptoms persisted, escalating to 15 watery bowel movements daily.

The patient was started on upadacitinib after failing to respond to prior interventions. Within weeks, she reported a marked reduction in symptoms, with bowel movements normalizing to one formed stool daily. Repeat sigmoidoscopy confirmed a decrease in inflammation, with biopsies showing reduced lymphocytic infiltration.

This is only the second report in the literature documenting successful treatment of lymphocytic colitis with upadacitinib. The findings suggest a potential role for JAK1 inhibitors in managing refractory microscopic colitis, where treatment options remain limited.

“This case highlights another treatment for clinicians to consider in their therapeutic algorithm for refractory cases.,” the authors concluded.

Reference:

Bhaskar S, Narayanan S, Rosario M. Refractory lymphocytic colitis treated with upadacitinib. Presented at: Advances in Inflammatory Bowel Disease annual meeting; December 9-11, 2024. Orlando, Florida.