Intensified Upadacitinib Dosing for Adolescent Patients with Acute Severe Ulcerative Colitis

Background/Objectives : In adolescent patients with ulcerative colitis refractory to anti-tumor necrosis factor (TNF) therapy, episodes of acute severe ulcerative colitis (ASUC) require hospitalization or surgery. Upadacitinib can be a potential colectomy-sparing agent in adult ASUC patients receiving intensified dosing. Methods : This case series evaluates clinical outcomes of intensified rescue upadacitinib dosing in adolescent patients with ASUC. We included adolescents admitted with anti-TNF refractory ASUC treated with 30 mg twice daily upadacitinib. The primary outcome was the proportion of patients who remained colectomy-free at the most recent follow-up. Results : Five patients (aged 14-18) exhibited varying responses to upadacitinib; 2 responded rapidly, while 3 had partial response. All the patients remained on upadacitinib and were colectomy-free during follow-up (55-203 days). Three (60%) ultimately received dual advanced therapy with ustekinumab and upadacitinib. At most recent follow-up, 60% were in clinical/biochemical remission without corticosteroids. Conclusions : In select cases, intensified upadacitinib may be a potential colectomy-sparing option for adolescent ASUC patients refractory to anti-TNF therapy

Dosing · Intensive care medicine · Ulcerative colitis · Inflammatory Bowel Disease · Intestinal Malrotation and Obstruction Disorders · Medicine · Microscopic Colitis · Internal Medicine

• Efficacy of Modified Upadacitinib Dosing in Pediatric Refractory IBD

  Open Access•Frank Rommel, Frank Risto Rommel et al.•Children•2025

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