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- IBD
- Upadacitinib induction is effective and safe in ulcerative colitis patients including those with prior exposure to tofacitinib: a multicenter real-world cohort study
- Robert Gilmore, Richard Fernandes, Imogen Hartley, Arteen Arzivian, Rupert Leong, Bridgette Andrew, Abhinav Vasudevan, Tessa Greeve, Gregory Thomas Moore, Steven Kim, Daniel Lightowler, Abhey Singh, Gillian Mahy, Aditya Mithanthaya, Kannan Venugopaul, Sangwoo Han, Robert Bryant, Jack West, Jonathan Segal, Britt Christensen, Crispin Corte, Nik Ding, Yoon-Kyo An, Jakob Begun
- Intest Res 2025;23(3):347-357. Published online December 20, 2024
- DOI: https://doi.org/10.5217/ir.2024.00127
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Abstract
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PubReader
ePub - Background/Aims
Upadacitinib is a novel selective Janus kinase inhibitor approved for use in ulcerative colitis. Clinical trials had rigorous criteria and excluded many patient subgroups. Given limited real-world effectiveness data, we examined outcomes of patients treated with upadacitinib for ulcerative colitis in a real-world population.
Methods
Patients that commenced upadacitinib for moderate-to-severe ulcerative colitis from September 2022 until March 2023 were identified at 13 inflammatory bowel disease centers across Australia. Clinical, biochemical, endoscopic, and intestinal ultrasound outcomes were recorded retrospectively at baseline, week 8, and week 16.
Results
One hundred and fifty-two patients (61 female [40%], median age 38 years [interquartile range, 28–50]) were included. The primary endpoint of clinical remission was met in 79% at week 8, and 84% at week 16. A total of 42 patients (28%) with prior tofacitinib exposure were included. No significant difference in clinical remission was observed by week 16 between tofacitinib experienced compared to tofacitinib naïve patients (86% vs. 84%, P= 0.67). Complete intestinal ultrasound data was available for 36 patients, showing transmural remission in 64% at week 8 and 81% at week 16, with a decrease in median bowel wall thickness of 2.3 mm and 2.4 mm, respectively.
Conclusions
Upadacitinib resulted in high rates of clinical remission at 8 and 16 weeks in this large real-world cohort of ulcerative colitis patients. Upadacitinib is effective in patients with prior tofacitinib exposure. Intestinal ultrasound shows significant rates of transmural remission at week 8, sustained through week 16. -
Citations
Citations to this article as recorded by
- Letter: Toward Intra‐Class Switching With JAK Inhibitors?
Mathieu Uzzan, David Laharie
Alimentary Pharmacology & Therapeutics.2025; 61(5): 919. CrossRef - Effectiveness and Safety of a Second JAK Inhibitor in Ulcerative Colitis: The J2J Multicentre Study
Mathilde Osty, Romain Altwegg, Mélanie Serrero, Alban Benezech, Albane Lecomte, Guillaume Cadiot, Lucine Vuitton, Anne Wampach, Stéphane Nancey, Anthony Buisson, Catherine le Berre, Clea Rouillon, Cyrielle Gilletta, Felix Goutorbe, Mathurin Fumery, Nassim
Alimentary Pharmacology & Therapeutics.2025; 62(4): 430. CrossRef - Upadacitinib and vedolizumab combination therapy for the management of refractory ulcerative colitis and Crohn’s disease
Robert Gilmore, Amrutha Murali, Amirah Etchegaray, Ei Swe, Yoon-Kyo An, Jakob Begun
Intestinal Research.2025; 23(4): 475. CrossRef - Upadacitinib after tofacitinib in ulcerative colitis
Hyeon Jin Cho, Eun Soo Kim
Intestinal Research.2025; 23(3): 229. CrossRef - A Comparison of the Efficacy and Safety of Ustekinumab and Upadacitinib in Biologically Experienced Ulcerative Colitis Patients
Osman Özdoğan, Serkan Yaraş, Mehmet Kasım Aydın, Fehmi Ateş, Engin Altıntaş, Orhan Sezgin
Biomedicines.2025; 13(10): 2455. CrossRef - Is 2nd JAKi treatment for UC worth the effort? A retrospective, multi-centre UK study
Chandni Radia, Yaa Danso, Susan Ritchie, Melissa Hale, Alexander T Elford, Chirag Patel, Lucy Hicks, Sonia Kalyanji, Chaonan Dong, Katie Yeung, Jie Han Yeo, Mohammed Allah-Ditta, Maria Bishara, Karishma Sethi-Arora, Lushen Pillay, Emma L Johnston, Ruth Ru
Journal of Crohn's and Colitis.2025;[Epub] CrossRef - IBD 2024: Charting a New Course in IBD Proceedings of the Takeda Symposium 22–23 November 2024 W Hotel, Brisbane, Queensland, Australia
Uma Mahadevan, Vipul Jairath, Jakob Begun, Aviv Pudipeddi, Mayur Garg, Peter De Cruz, Christopher F. D. Li Wai Suen, Matthew C. Choy, Danny Con, Rose Vaughan, John D. Chetwood, David A. Clark, Craig Haifer, Miles P. Sparrow, Rupert Leong, Réme Mountifield
Journal of Gastroenterology and Hepatology.2025; 40(S3): 3. CrossRef - Three Janus kinase inhibitors in ulcerative colitis: is upadacitinib taking the lead?
Yoon Suk Jung
Intestinal Research.2025; 23(4): 394. CrossRef - Upadacitinib’s Effectiveness and Safety as a Second- or Third-Line Therapy in Patients with Ulcerative Colitis: Data from a Real-World Study
Giammarco Mocci, Antonio Tursi, Franco Scaldaferri, Daniele Napolitano, Daniela Pugliese, Giovanni Maconi, Giovanni Cataletti, Roberta Pica, Claudio Cassieri, Edoardo Vincenzo Savarino, Caterina De Barba, Francesco Costa, Linda Ceccarelli, Manuela Marzo,
Journal of Clinical Medicine.2025; 14(21): 7801. CrossRef - Optimizing Janus kinase inhibitor therapy for ulcerative colitis: a real-world perspective
Shintaro Akiyama
Intestinal Research.2025;[Epub] CrossRef - Janus Kinase Inhibitors for Inflammatory Bowel Disease: Concise Questions and Answers on Their Use in Clinical Practice
Javier P Gisbert, María Chaparro
Inflammatory Bowel Diseases.2025;[Epub] CrossRef
- Letter: Toward Intra‐Class Switching With JAK Inhibitors?
- 8,201 View
- 416 Download
- 11 Web of Science
- 11 Crossref
- IBD
- Biomarker dynamics during infliximab salvage for acute severe ulcerative colitis: C-reactive protein (CRP)-lymphocyte ratio and CRP-albumin ratio are useful in predicting colectomy
- Danny Con, Bridgette Andrew, Steven Nicolaides, Daniel R van Langenberg, Abhinav Vasudevan
- Intest Res 2022;20(1):101-113. Published online March 12, 2021
- DOI: https://doi.org/10.5217/ir.2020.00146
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Abstract
PDF
Supplementary MaterialPubReaderePub - Background/Aims
The residual risk of colectomy after infliximab salvage in steroid-refractory acute severe ulcerative colitis (ASUC) is required to inform the need for subsequent maintenance biologic therapy. The aim of this study was to determine the dynamic response of common serum biomarkers to infliximab salvage and assess their utility in predicting subsequent colectomy.
Methods
A retrospective single-center cohort study was conducted on all patients who received infliximab salvage for steroid-refractory ASUC between January 1, 2010, and July 31, 2019. Biomarkers were assessed on admission and days 1 and 3 post infliximab, and included C-reactive protein (CRP)-albumin-ratio (CAR), CRP-lymphocyte-ratio (CLR), platelet-lymphocyte-ratio (PLR) and neutrophil-lymphocyte-ratio (NLR).
Results
Of 94 patients (median age, 35 years; 67% of male), 20% required colectomy at 12 months. Biomarkers on day 3 post-infliximab best differentiated nonresponders, who had higher CRP, lower albumin and lower lymphocyte count (each P< 0.05). Day 3 predictive performance (area under the curve) for 12-month colectomy was best for CAR (0.871) and CLR (0.874), which were similar to Lindgren (0.829; P> 0.05) but superior to Mayo (0.726), partial Mayo (0.719), PLR (0.719), Ho index (0.714), NLR (0.675), Travis score (0.657) and endoscopic Mayo (0.609) (each P< 0.05). A day 3 CAR cutoff of 0.47 mg/g had 79% sensitivity, 80% specificity, 94% negative predictive value (NPV) to predict colectomy; while a day 3 CLR cutoff of 6.0 mg/109 had 84% sensitivity, 84% specificity, 96% NPV.
Conclusions
CAR and CLR measured on day 3 post infliximab salvage for steroid-refractory ASUC represent simple and routinely performed biomarkers that appear to be strong predictors of colectomy. Prospective studies are required to confirm the utility of these predictive scores. -
Citations
Citations to this article as recorded by- Endoscopic severity and C-reactive protein predict initial and 12-month outcomes of second-line medical therapy in acute severe ulcerative colitis: the RESCUE-ASC study
Pradeep Kakkadasam Ramaswamy, Deloshaan Subhaharan, Thomas Chapman, John Edwards, Lauren White, Desmond Patrick, Asif Shahzad, Laura Willmann, Dheeraj Shukla, Naveed Ishaq, Maneesha Bhullar, Alexander Dorrington, Jack Satsangi, Waled Mohsen
Frontline Gastroenterology.2025; : flgastro-2025-103253. CrossRef - Scoring indices for assessing endoscopic disease activity in acute severe ulcerative colitis: a systematic review
Hadar Meringer, Maia Kayal, Vipul Jairath, Anila Qasim, John K Macdonald, Yuhong Yuan, Christopher Ma, Jean-Frederic Colombel
Journal of Crohn’s and Colitis.2025;[Epub] CrossRef - Preoperative C-reactive protein-to-albumin ratio for perioperative risk stratification in penetrating crohn’s disease: identification of a candidate rule-out threshold (a propensity score-matched cohort study)
Kinuko Nagayoshi, Yusuke Mizuuchi, Takaaki Fujimoto, Koji Tamura, Kohei Nakata, Kenoki Ohuchida, Masafumi Nakamura
Surgery Today.2025;[Epub] CrossRef - Serum Procalcitonin Values Relate to Disease Activity in Patients with Inflammatory Bowel Diseases
İrfan Küçük, Süleyman Baş
Konuralp Tip Dergisi.2025; 17(1): 60. CrossRef - In Acute Severe Ulcerative Colitis Patients Who Receive Rescue Therapy, Prior Maintenance Therapy and Day 3 C-Reactive Protein After Rescue Therapy Are Associated With 12-Month Colectomy Risk
Jared A Sninsky, Ana-Maria Staicu, Edward L Barnes
Inflammatory Bowel Diseases.2024; 30(10): 1911. CrossRef - Factors Associated With Response to Rescue Therapy in Acute Severe Ulcerative Colitis
Christopher F D Li Wai Suen, Dean Seah, Matthew C Choy, Peter De Cruz
Inflammatory Bowel Diseases.2024; 30(8): 1389. CrossRef - Unresolved challenges in acute severe ulcerative colitis
Sudheer K. Vuyyuru, Vipul Jairath
Indian Journal of Gastroenterology.2024; 43(1): 9. CrossRef - Ischemia-modified albumin: a novel blood marker of endoscopic mucosal healing in inflammatory bowel disease
Seung Bum Lee, Hyun-Ki Kim, Sang Hyuk Park, Ji-Hun Lim, Sang Hyoung Park
Intestinal Research.2024; 22(1): 75. CrossRef - Medical treatment selection and outcomes for hospitalized patients with severe ulcerative colitis as defined by the Japanese criteria
Makoto Naganuma, Naohiro Nakamura, Reiko Kunisaki, Katsuyoshi Matsuoka, Shojiro Yamamoto, Ami Kawamoto, Daisuke Saito, Taku Kobayashi, Kosaku Nanki, Kazuyuki Narimatsu, Hisashi Shiga, Motohiro Esaki, Shinichiro Yoshioka, Shingo Kato, Masayuki Saruta, Shin
Journal of Gastroenterology.2024; 59(4): 302. CrossRef - Which biomarkers best reflect the degree of inflammation in Crohn’s disease?
Jihye Park
Intestinal Research.2024; 22(1): 1. CrossRef - Acute severe ulcerative colitis management: unanswered questions and latest insights
Pauline Rivière, Christopher Li Wai Suen, María Chaparro, Peter De Cruz, Antonino Spinelli, David Laharie
The Lancet Gastroenterology & Hepatology.2024; 9(3): 251. CrossRef - Predictors of adverse outcomes of steroids in patients with severe ulcerative colitis (systematic review and meta-analyses)
A. F. Mingazov, O. I. Sushkov, B. R. Kalanov, T. A. Baranova, S. I. Achkasov
Koloproktologia.2024; 23(1): 172. CrossRef - Exploring the Role of GDF-15 in Inflammatory Bowel Disease: A Case-Controlled Study Comparing Crohn’s Disease and Ulcerative Colitis with Non-Inflammatory Controls
Ondřej Kučerka, Marie Blahutová, Vít Kosek, Petra Mináriková, Jan M. Horáček, Petr Urbánek, Martin Malý
Metabolites.2024; 14(4): 185. CrossRef - Clinical utility of C‐reactive protein‐to‐albumin ratio in the management of patients with inflammatory bowel disease
Anke L Nguyen, Claudia Brick, David Liu, David J Gibson, Peter R Gibson, Miles P Sparrow
JGH Open.2024;[Epub] CrossRef - Predicting Outcome after Acute Severe Ulcerative Colitis: A Contemporary Review and Areas for Future Research
Sudheer Kumar Vuyyuru, Olga Maria Nardone, Vipul Jairath
Journal of Clinical Medicine.2024; 13(15): 4509. CrossRef - Fecal, Blood, and Urinary Biomarkers in Inflammatory Bowel Diseases
Sarah Bencardino, Ferdinando D’Amico, Alessandra Zilli, Tommaso Lorenzo Parigi, Mariangela Allocca, Gionata Fiorino, Silvio Danese, Federica Furfaro
Journal of Translational Gastroenterology.2024; 2(2): 61. CrossRef - C-reactive protein-to-lymphocyte ratio is a novel biomarker for predicting the long-term efficacy of ustekinumab treatment in ulcerative colitis
Ryoji Koshiba, Kazuki Kakimoto, Noboru Mizuta, Keijiro Numa, Naohiko Kinoshita, Kei Nakazawa, Yuki Hirata, Takako Miyazaki, Kazuhide Higuchi, Shiro Nakamura, Hiroki Nishikawa, Senthilnathan Palaniyandi
PLOS ONE.2024; 19(8): e0305324. CrossRef - Defining management strategies for acute severe ulcerative colitis using predictive models: a simulation-modeling study
Danny Con, Peter De Cruz
Intestinal Research.2024; 22(4): 439. CrossRef - Predictors for colectomy in patients with acute severe ulcerative colitis: a systematic review and meta-analysis
Jieqi Zheng, Zinan Fan, Chao Li, Daiyue Wang, Shenghong Zhang, Rirong Chen
BMJ Open Gastroenterology.2024; 11(1): e001587. CrossRef - Can Inflammatory Indexes Predict the Severity of Mucosal Inflammation in Ulcerative Colitis?
İrfan Küçük, Ersin Tural
Duzce Medical Journal.2024; 26(3): 191. CrossRef - Nutrition, Nutritional Status, Micronutrients Deficiency, and Disease Course of Inflammatory Bowel Disease
Marco Valvano, Annalisa Capannolo, Nicola Cesaro, Gianpiero Stefanelli, Stefano Fabiani, Sara Frassino, Sabrina Monaco, Marco Magistroni, Angelo Viscido, Giovanni Latella
Nutrients.2023; 15(17): 3824. CrossRef - Systematic review: Scores used to predict outcomes in acute severe ulcerative colitis
Maia Kayal, Hadar Meringer, Lily Martin, Jean Frederic Colombel
Alimentary Pharmacology & Therapeutics.2023; 58(10): 974. CrossRef - Clinical significance of the C-reactive protein-to-bilirubin ratio in patients with ulcerative colitis
Xijing Huang, Ya Liu, Zhou Zhou, Yan Pan, Yinghui Zhang, Caiping Gao, Chong He
Frontiers in Medicine.2023;[Epub] CrossRef - Exploring the diagnostic and prognostic value of the C-reactive protein/lymphocyte ratio for dilated cardiomyopathy based on a real-world study
Bin Qi, Zhi-Jie Yang, Nan Huang, Wen-Bo Zheng, Chun Gui
Scientific Reports.2023;[Epub] CrossRef - Novel Utility of Leucine-Rich Alpha-2-Glycoprotein as a Biomarker in Ulcerative Colitis: A Predictor of Endoscopic Remission Independent of Symptoms
Tomoyuki Hayashi, Kazuya Kitamura, Masaaki Usami, Masaki Miyazawa, Masaki Nishitani, Akihiro Dejima, Makoto Yamamoto, Shotaro Kawase, Masaya Funaki, Noriaki Orita, Hidetoshi Nakagawa, Koki Morita, Noriho Iida, Akihiro Seki, Kouki Nio, Hidenori Kido, Hideo
Inflammatory Intestinal Diseases.2023; 8(4): 133. CrossRef - Current and emerging biomarkers for ulcerative colitis
Jan K. Nowak, Rahul Kalla, Jack Satsangi
Expert Review of Molecular Diagnostics.2023; 23(12): 1107. CrossRef - Effect of disease duration on the association between C-reactive protein-albumin ratio and endoscopic activity in ulcerative colitis
Shinya Furukawa, Sen Yagi, Kana Shiraishi, Teruki Miyake, Kazuhiro Tange, Yu Hashimoto, Shogo Kitahata, Tomoe Kawamura, Tomoyuki Ninomiya, Kenichirou Mori, Seiyuu Suzuki, Naozumi Shibata, Hidehiro Murakami, Katsuhisa Ohashi, Aki Hasebe, Hideomi Tomida, Ya
BMC Gastroenterology.2022;[Epub] CrossRef - Inflammatory Indexes for Assessing the Severity and Disease Progression of Ulcerative Colitis: A Single-Center Retrospective Study
Hanyang Lin, Zhaohui Bai, Qiong Wu, Guiyang Chu, Yongguo Zhang, Xiaozhong Guo, Xingshun Qi
Frontiers in Public Health.2022;[Epub] CrossRef - Clinical outcomes and predictors of response for adalimumab in patients with moderately to severely active ulcerative colitis: a KASID prospective multicenter cohort study
Seung Yong Shin, Soo Jung Park, Young Kim, Jong Pil Im, Hyo Jong Kim, Kang-Moon Lee, Ji Won Kim, Sung-Ae Jung, Jun Lee, Sang-Bum Kang, Sung Jae Shin, Eun Sun Kim, You Sun Kim, Tae Oh Kim, Hyun-Soo Kim, Dong Il Park, Hyung Kil Kim, Eun Soo Kim, Young-Ho Ki
Intestinal Research.2022; 20(3): 350. CrossRef - Does C-reactive protein to serum Albumin Ratio correlate with diabEtic nephropathy in patients with Type 2 dIabetes MEllitus? The CARE TIME study
Satilmis Bilgin, Ozge Kurtkulagi, Burcin Meryem Atak Tel, Tuba Taslamacioglu Duman, Gizem Kahveci, Atiqa Khalid, Gulali Aktas
Primary Care Diabetes.2021; 15(6): 1071. CrossRef - Inflammatory Bowel Disease and Neutrophil–Lymphocyte Ratio: A Systematic Scoping Review
Blake O. Langley, Sara E. Guedry, Joshua Z. Goldenberg, Douglas A. Hanes, Jennifer A. Beardsley, Jennifer Joan Ryan
Journal of Clinical Medicine.2021; 10(18): 4219. CrossRef
- Endoscopic severity and C-reactive protein predict initial and 12-month outcomes of second-line medical therapy in acute severe ulcerative colitis: the RESCUE-ASC study
- 12,267 View
- 368 Download
- 33 Web of Science
- 31 Crossref
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