Real-world patients with perianal Crohn’s disease fare well with upadacitinib

In patients with perianal Crohn’s disease (pCD) treated in routine clinical practice, the use of upadacitinib appears to have a beneficial effect on fistula outcomes, with a more pronounced effect seen for anti-TNF–naïve patients and those with shorter disease duration, according to a multicentre retrospective cohort study.

The study included 125 patients (median age 33 years, 56 percent male) with pCD who received treatment with upadacitinib across 10 North American centres. Forty-eight percent of patients had complex fistulas, and 77.4 percent had prior exposure to anti-TNF medications.

Clinical response, defined as a ≥3-point reduction in the Perianal Disease Activity Index (PDAI), was the primary outcome. Secondary outcomes included clinical remission (PDAI ≤4- and ≥3-point decrease or no worsening), ≥50-percent C-reactive protein (CRP) concentration reduction, pelvic MRI outcomes, and rates of hospitalization, antibiotic use, and pCD-related surgery.

During follow-up, 45.5 percent of patients achieved clinical response, and 39.4 percent had clinical remission. Hospitalization occurred in 5.1 percent of patients, and perianal surgery was performed in 13.1 percent.

Amont 78 patients who underwent pelvic MRI, 55.1 percent showed improvement and 11.5 percent completely healed.

Clinical response rate was notably higher among anti-TNF–naïve vs anti-TNF–experienced patients (66.7 percent vs 33.3 percent; p=0.001) and those with shorter disease duration (54.7 percent vs 33.3 percent; p=0.04).

Further analysis confirmed prior anti-TNF exposure as a predictor of lower clinical response (hazard ratio, 0.38, 95 percent confidence interval, 0.22–0.66; p<0.001).