Upadacitinib as rescue therapy in acute severe ulcerative colitis: a Malaysia tertiary center experience

Ban Hong, Ang and Nik Muhamad Affendi, Nik Arsyad and Hilmi, Ida Normiha (2023) Upadacitinib as rescue therapy in acute severe ulcerative colitis: a Malaysia tertiary center experience. Journal of Gastroenterology and Hepatology, 38 (S3). p. 263. ISSN 0815-9319 E-ISSN 1440-1746

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Abstract

Introduction:The critical nature of acute severe ulcerative colitis (ASUC),often necessitating emergent colectomy, highlights the pressing need to ex-plore alternative rescue medical therapy. We report two cases ofupadacitinib as rescue therapy in biologic-experienced patients withASUC.Case 1A 17-year-old girl with longstanding refractory extensive ulcerative colitis.She was initially on adalimumab but was switched to infliximab due to pri-mary nonresponse. Despite receiving 10 mg/kg of infliximab 4 weekly for8 weeks, she had persistent abdominal pain, diarrhea, and per-rectal bleed-ing. She refused colectomy and wasfinally started on upadacitinib 45 mgOD for 1 month, but due to suboptimal response, dose was increased to30 mg BD. She achieved partial clinical response at Week 8.Case 2A 70-year-old woman with 10-year history of left sided colitis developedsecondary loss of response to vedolizumab after 4 years and was switchedto ustekinumab in April 2023. Despite treatment, she presented with ASUCafter 2 months. She refused surgery and was then started on intravenoushydrocortisone 100 mg QDS for 7 days and upadacitinib 45 mg OD. Sheshowed initial clinical response and was discharged. Unfortunately, shewas readmitted with rectal bleed from a visible vessel which settled afterhemostatic therapy (clipping). After 4 weeks on upadacitinib, she achievedclinical remission. She received 8 weeks of 45 mg OD upadacitinib and isnow on 30 mg OD.Further clinical and endoscopic details, refer to Table 1.Conclusions:Upadacitinib appears to be promising as a rescue therapy inbiologic-experienced patients with ASUC.

Item Type:	Article (other)
Subjects:	R Medicine > R Medicine (General)
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Medicine
Depositing User:	Dr Nik Arsyad Nik Muhamad Affendi
Date Deposited:	16 Jan 2024 09:47
Last Modified:	16 Jan 2024 09:53
URI:	http://irep.iium.edu.my/id/eprint/110172

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