Comparative Effectiveness of Low Versus High Dose Upadacitinib as Maintenance Treatment in Patients With Ulcerative Colitis: A Real-World Cohort Study From the United States

Authors

• Priya Sehgal, Thomas Jefferson UniversityFollow
• Gursimran S. Kochhar
• Harpreet Kaur
• Himsikhar Khataniar
• Raina Shivashankar, Thomas Jefferson UniversityFollow
• James D. Lewis
• Aakash Desai

Document Type

Article

Publication Date

5-8-2026

Comments

This article is the author’s final published version in Crohn's and Colitis 360, Volume 8, Issue 2, 2026, Article number otag028.

The published version is available at https://doi.org/10.1093/crocol/otag028. Copyright © The Author(s) 2026.

Abstract

BACKGROUND: There is limited real-word data comparing efficacy of low dose upadacitinib (UPA) to high dose UPA as maintenance therapy for ulcerative colitis (UC).

METHODS: This was a retrospective cohort study utilizing the U.S. Collaborative Network in adults ≥18 years old with UC who initiated UPA 15 mg compared to 30 mg for maintenance therapy between April 2022 and December 2023. The primary outcome was a composite of intravenous steroid use, oral steroid use, or colectomy from 12 to 60 weeks from the index UPA prescription. Propensity score matching (PSM) was performed for demographics, co-morbid conditions, laboratory, and IBD medication history. Cox proportional hazard model was used to identify predictors of failure.

RESULTS:  Among 1110 patients on UPA maintenance therapy, 361 (32.5%) were on 15 mg and 749 (67.5%) were on 30 mg. After PSM, there was no difference in the composite outcome of steroid use or colectomy between the 15-mg UPA cohort versus 30 mg cohort (35.3% vs 35.6%; aHR 0.95, 0.71-1.24, P = .8). There was no difference in IV steroid use, oral steroid use or change in therapy between the two cohorts. There was no difference in the proportion of patients who achieved a fecal calprotectin of < 250 μg/g (55.8% vs 63.5%, P = .33). Recent oral or IV steroid use and rheumatoid arthritis were associated with failure of both 15 mg and 30 mg UPA.

CONCLUSION: Our study indicates that 15 mg UPA shows similar efficacy as 30 mg UPA for maintenance treatment in a subset of patients with UC.

Recommended Citation

Sehgal, Priya; Kochhar, Gursimran S.; Kaur, Harpreet; Khataniar, Himsikhar; Shivashankar, Raina; Lewis, James D.; and Desai, Aakash, "Comparative Effectiveness of Low Versus High Dose Upadacitinib as Maintenance Treatment in Patients With Ulcerative Colitis: A Real-World Cohort Study From the United States" (2026). Division of Gastroenterology and Hepatology Faculty Papers. Paper 131.
https://jdc.jefferson.edu/gastro_hepfp/131

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 License.

PubMed ID

42137135

Language

English