Have we hit the JAK-pot? Success of selective JAK 1 inhibitor following failure of pan-JAK inhibitor in refractory pediatric ulcerative colitis.

The treatment options available for pediatric ulcerative colitis (UC) are challenging due to few with Federal Drug Administration approval. Newer medications approved for adults include additional biologics with differing mechanisms of action and small molecule drugs, such as Janus kinase (JAK) inhibitors. Our case outlines a patient with refractory UC who failed mesalamine, adalimumab, tofacitinib, and vedolizumab. She was evaluated for colectomy, but upadacitinib was trialed. She achieved rapid clinical remission and avoided surgery. This case demonstrates the failure of a pan-JAK inhibitor (tofacitinib) and response to a more selective JAK 1 inhibitor (upadacitinib).