Patients with Crohn's Disease and Ileostomy Can Respond to Upadacitinib

Area of Science:

• Gastroenterology
• Immunology

Background:

• Janus kinase (JAK) inhibitors are used for inflammatory bowel disease.
• Previous studies excluded patients with an ileostomy.
• The efficacy of upadacitinib in Crohn's disease (CD) patients with an ileostomy is not well-established.

Purpose of the Study:

• To evaluate the clinical response to upadacitinib in patients with Crohn's disease and an ileostomy.
• To identify factors influencing upadacitinib discontinuation in this patient population.

Main Methods:

• Retrospective study of 48 patients with CD and an ileostomy treated with upadacitinib.
• Analysis of patients who underwent ileostomy takedown versus those with a persistent ileostomy.
• Primary endpoint: clinical response (upadacitinib continuation/discontinuation).

Main Results:

• 67% of patients (32/48) showed clinical improvement in CD activity.
• Upadacitinib was discontinued in 33% of patients (16/48) due to various reasons.
• Reasons for discontinuation included refractory symptoms, adverse events, and insurance denial.

Conclusions:

• Upadacitinib demonstrated efficacy in improving CD symptoms for two-thirds of patients with an ileostomy.
• Further investigation is required to determine the impact of altered gastrointestinal anatomy on upadacitinib absorption and effectiveness in CD patients.