D0365 - Upadacitinib for Refractory Crohn’s Disease

Tuesday, October 25, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Taylor A. Riggs, MD

Vanderbilt University Medical Center
Nashville, TN

Taylor A. Riggs, MD, Adam Neimann, MD, Sara N. Horst, MD, Robin L. Dalal, MD, Elizabeth Scoville, MD, Baldeep Pabla, MD, Dawn B. Beaulieu, MD, David A. Schwartz, MD
Vanderbilt University Medical Center, Nashville, TN

Introduction: Despite many different pharmacologic therapies approved for the treatment of Crohn’s disease (CD), many patients are refractory to medical treatment. Upadacitinib (UPA) is an oral JAK-1 inhibitor, which was recently approved for use in ulcerative colitis. Studies looking at its efficacy in CD are ongoing and limited real-world data exists. In this retrospective study, we examine the efficacy and safety of UPA in patients with refractory CD.

Methods: Between July 2021 and May 2022, 11 patients with medically refractory CD were treated with UPA. 10 of the 11 patients had failed 3 or more advanced therapies. We retrospectively examined the response to treatment through prospectively collected patient-reported quality of life scores (SIBDQ questionnaire), Harvey Bradshaw indices (HBI), and laboratory data (ESR, CRP). Statistical analysis was performed with the Wilcoxon matched-pairs signed-rank test.

Results: 11 patients with refractory CD were included (Table 1). The median duration of therapy was 7 months (range 1-11 months). At the time of UPA initiation, 3 patients were on prednisone. 1 patient had to discontinue UPA after 3 months due to lack of efficacy. SIBDQ and HBI scores were documented in 6 patients before and after UPA. All 6 patients improved or were in clinical remission after UPA (Figure 1). ESR and CRP were documented in 10 patients pre and post UPA initiation. ESR significantly improved from 20.5 to 4.5. CRP showed a trend towards improvement. Of the 3 patients that were on prednisone at the start, 2 were able to reduce their dose by half and 1 was able to discontinue prednisone. Two patients developed soft tissue infections on UPA with 1 requiring hospitalization.

Discussion: In this study, we examined our center’s experience with UPA to treat refractory CD. Patients not only reported symptomatic improvement but also exhibited a downtrend in inflammatory markers. While our study does have significant limitations, our data suggests UPA may be a safe and effective option for those with refractory CD.

Figure: All patients showed improvement or were in clinical remission after starting UPA

Patient Characteristic		Number (%)
Gender	Male	3 (27)
Gender	Female	8 (73)
Years of disease	< 10	1 (9)
	10-20	7 (64)
	20-30	3 (27)
Number of advanced therapies failed	2	1 (9)
	3	2 (18)
	4	3 (27)
	5+	5 (45)

Table: Patient demographics and prior advanced therapies failed

Disclosures:

Taylor Riggs indicated no relevant financial relationships.

Adam Neimann indicated no relevant financial relationships.

Sara Horst: Abbvie – Consultant. Janssen – Consultant. Takeda – Consultant.

Robin Dalal: Abbvie – Advisor or Review Panel Member.

Elizabeth Scoville indicated no relevant financial relationships.

Baldeep Pabla indicated no relevant financial relationships.

Dawn Beaulieu: Abbvie – Consultant. Takeda – Consultant. UCB – Consultant.

David Schwartz: Abbvie – Consultant. BMS – Consultant. Genentech – Advisor or Review Panel Member. Gilead – Consultant. Janssen – Consultant. Pfizer – Consultant. Takeda – Consultant. UCB – Consultant.

Taylor A. Riggs, MD, Adam Neimann, MD, Sara N. Horst, MD, Robin L. Dalal, MD, Elizabeth Scoville, MD, Baldeep Pabla, MD, Dawn B. Beaulieu, MD, David A. Schwartz, MD. D0365 - Upadacitinib for Refractory Crohn’s Disease, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.