Upadacitinib as rescue therapy in acute severe ulcerative colitis: a Malaysia tertiary center experience

• Main Authors: Ban Hong, Ang, Nik Muhamad Affendi, Nik Arsyad, Hilmi, Ida Normiha
• Format: Article
• Language: English
• Published: Wiley 2023
• Subjects: R Medicine (General)
• Online Access: http://irep.iium.edu.my/110172/6/110172_Upadacitinib%20as%20rescue%20therapy%20in%20acute%20severe%20ulcerative.pdf; http://irep.iium.edu.my/110172/; https://onlinelibrary.wiley.com/doi/10.1111/jgh.16422; https://doi.org/10.1111/jgh.16421
• Institution: Universiti Islam Antarabangsa Malaysia

Introduction:The critical nature of acute severe ulcerative colitis (ASUC),often necessitating emergent colectomy, highlights the pressing need to ex-plore alternative rescue medical therapy. We report two cases ofupadacitinib as rescue therapy in biologic-experienced patients withASUC.Case 1A 17-year-old girl with longstanding refractory extensive ulcerative colitis.She was initially on adalimumab but was switched to infliximab due to pri-mary nonresponse. Despite receiving 10 mg/kg of infliximab 4 weekly for8 weeks, she had persistent abdominal pain, diarrhea, and per-rectal bleed-ing. She refused colectomy and wasfinally started on upadacitinib 45 mgOD for 1 month, but due to suboptimal response, dose was increased to30 mg BD. She achieved partial clinical response at Week 8.Case 2A 70-year-old woman with 10-year history of left sided colitis developedsecondary loss of response to vedolizumab after 4 years and was switchedto ustekinumab in April 2023. Despite treatment, she presented with ASUCafter 2 months. She refused surgery and was then started on intravenoushydrocortisone 100 mg QDS for 7 days and upadacitinib 45 mg OD. Sheshowed initial clinical response and was discharged. Unfortunately, shewas readmitted with rectal bleed from a visible vessel which settled afterhemostatic therapy (clipping). After 4 weeks on upadacitinib, she achievedclinical remission. She received 8 weeks of 45 mg OD upadacitinib and isnow on 30 mg OD.Further clinical and endoscopic details, refer to Table 1.Conclusions:Upadacitinib appears to be promising as a rescue therapy inbiologic-experienced patients with ASUC.