Upadacitinib ‘may be better choice’ vs. ustekinumab for UC remission by week 16
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Key takeaways:
- Patients with UC had higher odds of clinical response and steroid-free clinical remission at 8-16 weeks on upadacitinib vs. ustekinumab.
- Endoscopic remission also was more likely with upadacitinib.
VANCOUVER, British Columbia — Patients with ulcerative colitis were more likely to achieve clinical response and steroid-free clinical remission at 8 to 16 weeks on upadacitinib vs. ustekinumab, according to a presenter.
“Some of the newer advanced therapies for ulcerative colitis have expanded to include inhibitors of interleukins 12 and 23, such as ustekinumab [(Stelara, Janssen)], and Janus kinase, such as tofacitinib [(Xeljanz, Pfizer)] and upadacitinib [(Rinvoq, AbbVie)],” Rahul S. Dalal, MD, MPH, a gastroenterologist and inflammatory bowel diseases specialist at Brigham and Women’s Hospital and Harvard Medical School, told attendees at the ACG Annual Scientific Meeting.
“However, there have been no clinical randomized trials that have directly compared these agents or these drug classes,” Dalal added. “Real-world data has suggested similar effectiveness of tofacitinib and ustekinumab for ulcerative colitis, but the comparative effectiveness of upadacitinib to ustekinumab is not known.”
Dalal and colleagues conducted a retrospective study of adults with UC who began treatment with upadacitinib (n = 70) or ustekinumab (n = 148) between Jan. 1, 2021, and Feb. 2, 2023, at two academic institutions. Baseline demographics and concurrent corticosteroid use were similar between groups, although Dalal noted there was a higher percentage of prior advanced therapy failures in the upadacitinib group.
The study’s primary outcome was clinical response at 8 to 16 weeks, defined by simple clinical colitis activity index improvement by at least 3 points, a partial Mayo score improvement of at least 3 points or provider assessment. Secondary outcomes were steroid-free clinical remission at 8 to 16 weeks and endoscopic response and remission within 52 weeks, while other outcomes included biochemical remission and improvement in arthralgia, if present.
According to unadjusted results, a higher proportion of patients in the upadacitinib group achieved primary and secondary outcomes, although endoscopic response, biochemical remission and treatment discontinuation were similar between groups.
“There were significantly higher odds of clinical response and steroid-free clinical remission at 8 to 16 weeks and endoscopic remission within 52 weeks for upadacitinib vs. ustekinumab, despite more advanced therapy failures in the upadacitinib group,” Dalal told Healio. “These findings suggest that upadacitinib may be more effective for induction of UC, particularly among the bio-exposed.”
Treatment discontinuation in both groups was primarily for non-response, Dalal noted, although two patients in the upadacitinib group and one in the ustekinumab group discontinued because of adverse events.
Results of weighted logistic regression demonstrated that there were higher odds of clinical response (OR = 2.39), steroid-free clinical remission (OR = 3.17) and endoscopic remission (OR = 5.1) with upadacitinib vs. ustekinumab; however, endoscopic response was similar between groups, Dalal said.
Adverse events in the 16-week period were similar to known safety profiles, although reports of angina and elevated liver enzymes in the upadacitinib group and bowel microperforation in the ustekinumab group led to treatment discontinuation.
“If choosing between upadacitinib and ustekinumab for ulcerative colitis and achieving remission by week 16 is a priority, upadacitinib may be a better choice,” Dalal told Healio. “However, our results need to be confirmed by larger, prospective studies.”
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Dalal RS, et al. Comparative effectiveness of upadacitinib vs. ustekinumab for ulcerative colitis at 8-16 Weeks: A multicenter retrospective cohort study. Presented at: ACG Annual Scientific Meeting; Oct. 20-25, 2023; Vancouver, British Columbia (hybrid meeting).
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