Upadacitinib Is Associated with the Lowest Risk of Treatment Failure Among Advanced Therapies for Ulcerative Colitis: A Real-World Administrative Claims Study.

BACKGROUND AND AIMS: We compared the real-world effectiveness of advanced therapies (AT) in patients with ulcerative colitis (UC).

METHODS

Using the OptumLabs® Data Warehouse, a nationally representative US administrative claims database, we identified patients with UC initiating infliximab, adalimumab, vedolizumab, ustekinumab, tofacitinib, or upadacitinib between 2016 and 2023. The primary outcome was time to treatment failure (composite of IBD-related hospitalization, IBD-related surgery, or new corticosteroid prescription occurring >90 days after index date); treatment discontinuation and switching were treated as censoring events. The secondary outcome was proportion of quarters in corticosteroid-free disease stability. Confounding was addressed using multinomial propensity score-based inverse probability weighting with generalized boosted models and competing risk adjustment for mortality.

RESULTS

We identified 7,283 patients contributing 9,078 treatment episodes with initiation of infliximab (n=1,624), adalimumab (n=2,315), vedolizumab (n=3,164), ustekinumab (n=1,274), tofacitinib (n=547), or upadacitinib (n=154). After IPW adjustment, upadacitinib was associated with significantly lower risk of treatment failure compared with infliximab (HR 0.61 [95% CI, 0.42-0.88]), adalimumab (HR 0.59 [0.41-0.86]), vedolizumab (HR 0.69 [0.48-1.00]), ustekinumab (HR 0.65 [0.45-0.95]), and tofacitinib (HR 0.59 [0.40-0.88]). Vedolizumab was associated with lower risk of treatment failure compared with infliximab (HR 0.88 [0.79-0.98]) and adalimumab (HR 0.86 [0.78-0.95]). Upadacitinib had the highest adjusted proportion of quarters in corticosteroid-free disease stability (0.70 [0.63-0.77]). Findings were consistent in patients with and without prior AT exposure.

CONCLUSIONS

In this large real-world UC cohort, upadacitinib was associated with the lowest risk of treatment failure and greatest corticosteroid-free disease stability compared with all other ATs evaluated.