Effectiveness of upadacitinib and tofacitinib for one year in ulcerative colitis in real clinical practice

AIM: to compare the one-year efficacy of upadacitinib (UPA) and tofacitinib (TOFA) for moderate to severe attacks of ulcerative colitis (UC).

PATIENTS AND METHODS: a retrospective study included electronic medical records of patients who were initiated by UPA and TOFA for the treatment of UC between January 2022 and January 2023. In consisted of 74 patients (37 in each group). In all patients, demographic data were assessed, the severity of the attack was assessed using the partial Mayo index, laboratory data, endoscopy at the start of therapy (day 0), at the 8th, 26th and 56th week of therapy, the incidence and nature of adverse events for the period of therapy. In order to create comparable groups for endoscopic activity before the start of therapy, the method of optimal pairing was used.

RESULTS: endoscopic response was found in 10/34 (29%) patients in the TOFA group and 18/36 (50%) in the UPA group (p = 0.08) when assessing changes in the endoscopic picture between 8 and 0 weeks of therapy; 14/30 (47%) on TOFA and 13/29 (45%) on UPA (p = 0.9) between 26 and 8 weeks; 6/26 (23%) on TOFA and 13/28 (46%) on UPA (p = 0.09) between 56 and 26 weeks, respectively. In the TOFA and UPA groups, endoscopic remission by week 56 was achieved in 18/26 (69%) patients and 15/28 (54%) patients, respectively. Secondary outcomes data did not reveal a significant difference between the 2 groups regarding optimization of therapy or the need for surgery. Laboratory data, as well as the severity of UC, did not differ between groups at all time control points.

CONCLUSION: endoscopic response and remission were not statistically different between the two groups. A randomized, prospective study is needed to compare the efficacy of upadacitinib with tofacitinib.

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