Janus Kinase Inhibitors for Acute Severe Ulcerative Colitis: Comparing Upadacitinib to Tofacitinib and Rescue to Sequential Salvage therapy
In brief
In severe colitis, upadacitinib users had 19 points fewer colectomies
In this 13-center retrospective study of 150 adults with acute severe ulcerative colitis, 23% of upadacitinib users had a colectomy by week 52, compared with 43% of tofacitinib users. The difference was not significant at earlier time points, and treatment was not randomly assigned, so whether upadacitinib itself explains the lower rate remains uncertain.
- Journal
- Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (Q1)
- Published
- 22 September 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Gilmore R, Fernandes R, Goetz N, Chin S, Con D, De Cruz P, et al.
- PMID
- 42772622
- DOI
- 10.1016/j.cgh.2026.09.017
Why clinicians should know about it
- Picked for Gastroenterology (paper of the day, 28 September 2026): Upadacitinib vs tofacitinib for acute severe ulcerative colitis
Abstract
BACKGROUND: Acute Severe Ulcerative Colitis (ASUC) remains a medical emergency with limited therapeutic options. Upadacitinib and tofacitinib are Janus kinase (JAK) inhibitors being increasingly used as rescue therapy for ASUC with limited data. We evaluated outcomes of JAK inhibitor use for ASUC over 52 weeks. METHODS: We undertook a multicentre retrospective cohort study across 13 Australian IBD centres. Adults with ASUC who commenced upadacitinib or tofacitinib from April 2021 to April 2024 were included. Outcomes were assessed during index admission, at week 8, 16, and 52. Comparisons of upadacitinib vs tofacitinib and rescue vs sequential salvage therapy were undertaken. The primary outcome for both analyses was colectomy by week 52. RESULTS: 150 patients were included with complete follow-up to 52 weeks. Upadacitinib was used in 51%, tofacitinib in 49%; JAK inhibitors as rescue therapy in 69% and sequential salvage therapy in 31%. Colectomy occurred in 33% of patients by week 52, and was significantly lower with upadacitinib than tofacitinib (23.4% vs 42.5%, weighted marginal risk difference -0.18, p=0.022), with no significance at earlier timepoints. Sequential salvage therapy resulted in a numerically higher rate of colectomy compared to Rescue therapy (38% vs 30%, adjusted marginal risk difference -0.1, p=0.239), but did not meet statistical significance. CONCLUSION: JAK inhibitors were effective for ASUC with a reassuring safety profile. Upadacitinib use resulted in a significantly lower rate of colectomy by week 52, with higher rates of clinical remission, CFCR, and biochemical remission during follow-up. Sequential salvage therapy may represent a viable therapeutic option for patients otherwise facing colectomy.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.