Biologic-exposed UC patients fare better with upadacitinib vs tofacitinib, ustekinumab

In the treatment of ulcerative colitis (UC) patients with prior advanced therapy failure, subsequent treatment with upadacitinib is associated with higher remission rates compared with tofacitinib and ustekinumab, according to the retrospective TRIDENT-UC study.

TRIDENT-UC included 312 patients (mean age at diagnosis 32.6 years, 571 percent female) who had failed at least one advanced therapy. For the subsequent treatment, 103 received upadacitinib (33 percent), 74 received tofacitinib (23.7 percent), and 135 received ustekinumab (43.3 percent).

Steroid-free clinical remission was the primary outcome, while endoscopic remission was a secondary outcome. Evaluations were conducted at weeks 16 and 52.

The respective steroid-free clinical remission rates at weeks 16 and 52 were 47.6 percent and 75 percent with upadacitinib, 27 percent and 52.4 percent with tofacitinib, and 26.7 percent and 53.4 percent with ustekinumab.

Endoscopic remission rates at weeks 16 and 52 were 38.1 percent and 56.8 percent with upadacitinib, 13.2 percent and 32.7 percent with tofacitinib, and 24.6 percent and 22.5 percent with ustekinumab, respectively.

In multivariable logistic regression analysis, upadacitinib was associated with two- to fourfold greater odds of achieving steroid-free clinical remission compared with tofacitinib (week 16: odds ratio [OR], 2.56, 95 percent confidence interval [CI], 1.16–5.64; week 52: OR, 3.14, 95 percent CI, 1.22–8.12) and ustekinumab (week 16: OR, 3.71, 95 percent CI, 1.88–7.29; week 52: OR, 4.68, 95 percent CI, 1.96–11.18).

For endoscopic remission, upadacitinib also outperformed tofacitinib (week 16: OR, 7.44, 95 percent CI, 2.09–26.53; week 52: OR, 3.51, 95 percent CI, 1.22–10.12) and ustekinumab (week 16: OR, 3.34, 95 percent CI, 1.38–8.09; week 52: OR, 8.69, 95 percent CI, 3.07–24.60).