Upadacitinib Is Safe and Effective in Older Adults: A Real-World Experience Comparing Safety and Efficacy in Younger Versus Older Adults with Inflammatory Bowel Disease.

PURPOSE: Upadacitinib (UPA), a selective Janus kinase (JAK) inhibitor, is a small molecule approved for the treatment of ulcerative colitis (UC) and Crohn's disease (CD) with limited data in the older adult population. We compared the safety and efficacy of UPA between younger (< 50 years) and older (≥ 50 years) adults with moderate-to-severe UC.

METHODS

We performed a single-center retrospective cohort study of adults treated with UPA monotherapy for UC between January 2015 and 2024. Demographic data, efficacy outcomes, and adverse events (AE) were collected over 24 months. Outcomes included were clinical response and remission assessed by partial Mayo score, endoscopic improvement, and histologic remission.

RESULTS

Participants totaled 120 (88 < 50 years and 32 ≥ 50 years). Age did not significantly impact clinical remission rates at 24 months (younger 55.7% vs older 53.1%, p = 0.80). Older patients had a significantly higher rate of both endoscopic (71.4% vs 34.2%, p < 0.05) and histologic remission (54.6% vs 16.7%, p < 0.05) at 24 months. Despite similar baseline severity levels, younger patients had a higher flare rate during maintenance therapy (32.2% vs 9.7% p < 0.05) and higher fecal calprotectin levels throughout the first year of therapy. There was no difference in the hospitalization rate for flares (p = 0.1) or IBD-related surgeries (p = 0.57). The rate of adverse events, notably herpes zoster, malignancy, and blood clot, did not differ significantly between the two groups.

CONCLUSION

Upadacitinib appears to be safe and effective for the treatment of moderate-severe UC in older adults.