Managing Secondary Loss of Response to Upadacitinib in IBD

Upadacitinib (UPA) is approved for moderately to severely active Crohn’s disease (CD) and ulcerative colitis (UC), with 45 mg once daily commonly used for induction before stepping down to lower maintenance doses. However, loss of response after dose reduction remains a clinically relevant challenge, and evidence to guide reinduction and long-term high-dose maintenance in routine practice is limited. To address this gap, a study evaluated the effects of reinduction and subsequent maintenance with 45 mg UPA in 181 patients with CD, UC, or unclassified inflammatory bowel disease (IBD). These patients initially responded to 45 mg UPA but experienced loss of response after dose de-escalation; 46 met criteria for reinduction.

Relapse occurred at a median of 21 weeks after dose reduction. Overall, 80.4% of patients recaptured clinical response after dose escalation. Furthermore, 93.8% of…