A NEW retrospective study provides real-world evidence supporting the effectiveness and safety of upadacitinib as induction therapy for patients with biologic-refractory Crohn’s disease (CD). Conducted at Union Hospital in Wuhan, China, the study highlights that upadacitinib, a selective Janus kinase 1 (JAK1) inhibitor, can achieve substantial clinical and endoscopic improvement in patients with limited treatment options.
Upadacitinib achieves remission and mucosal healing
The single-centre study evaluated 94 patients with active Crohn’s disease who received upadacitinib between June 2023 and February 2025. By week 12, 53.25% achieved clinical response and 42.86% achieved clinical remission. Endoscopic outcomes were similarly positive, with 50% achieving endoscopic response, 38.89% endoscopic remission, and 27.78% complete mucosal healing.
Biochemical markers of inflammation improved in parallel, with normalisation rates of 62.71% for C-reactive protein (CRP), 70.91% for erythrocyte sedimentation rate (ESR), and 29.63% for faecal calprotectin.
“These findings demonstrate that JAK1 inhibition through upadacitinib can induce both clinical and endoscopic remission in patients with Crohn’s disease who have previously failed biologic therapy,” the authors wrote.
Predictors of response and safety profile
Patients with lower baseline Crohn’s Disease Activity Index (CDAI) and Simple Endoscopic Score for Crohn’s Disease (SES-CD) were more likely to reach remission, suggesting that early intervention may enhance treatment outcomes.
Adverse events were reported in 34% of participants, most commonly lymphopenia, though the majority were mild to moderate in severity. The therapy was generally well tolerated, and no unexpected safety issues emerged during the induction phase.
Clinical implications
While controlled trials have confirmed its efficacy, this real-world study strengthens evidence that upadacitinib is an effective induction therapy for Crohn’s disease, particularly among patients unresponsive to biologics. The authors emphasised that larger, prospective studies are warranted to evaluate long-term safety and durability of response.
Refrence
Fu X et al. Upadacitinib induction therapy in Crohn’ s disease: a retrospective real-world study in biologic-refractory patients. BMC Gastroenterol. 2025;DOI: 10.1186/s12876-025-04305-z.
