Chung Chen-Shuan, Lee Wei-Wei, Le Puo-Hsien
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
Int J Colorectal Dis. 2025 Feb 11;40(1):33. doi: 10.1007/s00384-025-04825-w.
Acute severe ulcerative colitis (ASUC) is a medical emergent condition, and approximately one-third of patients with ASUC do not respond to corticosteroid. Whether small molecule drugs are efficient and safe for salvage therapy of ASUC is not well-understood.
Consecutive patients with ASUC who failed responding to first-line corticosteroid were retrospectively enrolled. Clinical, laboratory, endoscopic, and pathological data were analyzed.
Five Asian male patients (median age of 38.9 years old) with ASUC who received salvage therapy with upadacitinib were enrolled. The mean (± standard deviation) disease duration was 3.44 (± 3.30, 0.53 ~ 7.88) years. Baseline Montreal disease extent, C-reactive protein, and erythrocyte sedimentation rate were four (80%) E3 and one (20%) E2 disease, 40.54 (± 74.26) mg/dl, and 24.50 (± 19.09) mm/h, respectively. Daily upadacitinib 45 mg was prescribed for 56 days in all patients. Clinical response, clinical remission, corticosteroid-free remission, and endoscopic improvement at weeks 8 and 12 were achieved in five (100%) and five (100%), four (80%) and five (100%), four (80%) and five (100%), and four (80%) and five (100%) patients, respectively. One (20%) patient achieved histo-endoscopic remission at week 24. None of them had re-hospitalization or colectomy during the follow-up period but one patient developed penile simplex-1 infection which resolved after topical antiviral ointment without upadacitinib discontinuation.
Upadacitinib is an efficient salvage therapy for patients with ASUC. Further investigations are essential to assess long-term durability, safety profile, and viability as a bridging regimen in the treatment of ASUC.
急性重症溃疡性结肠炎（ASUC）是一种内科急症，约三分之一的ASUC患者对皮质类固醇无反应。小分子药物对ASUC挽救治疗的有效性和安全性尚不清楚。
回顾性纳入一线皮质类固醇治疗无效的连续性ASUC患者。分析临床、实验室、内镜和病理数据。
纳入5例接受乌帕替尼挽救治疗的亚洲男性ASUC患者（中位年龄38.9岁）。平均（±标准差）病程为3.44（±3.30，0.53至7.88）年。基线蒙特利尔疾病范围、C反应蛋白和红细胞沉降率分别为4例（80%）E3和1例（20%）E2疾病、40.54（±74.26）mg/dl和24.50（±19.09）mm/h。所有患者均服用每日45 mg乌帕替尼，持续56天。8周和12周时的临床缓解、临床缓解、无皮质类固醇缓解和内镜改善分别在5例（100%）、5例（100%）、4例（80%）和5例（100%）、4例（80%）和5例（100%）以及4例（80%）和5例（100%）患者中实现。1例（20%）患者在24周时实现组织内镜缓解。随访期间，他们均未再次住院或接受结肠切除术，但1例患者发生阴茎单纯疱疹病毒1型感染，在未停用乌帕替尼的情况下局部使用抗病毒软膏后感染得到缓解。
乌帕替尼是ASUC患者有效的挽救治疗药物。进一步研究对于评估其长期疗效、安全性以及作为ASUC治疗过渡方案的可行性至关重要。
