Is 2nd JAKi treatment for UC worth the effort? A retrospective, multi-centre UK study.

Radia, C.; Danso, Y.; Ritchie, S.; Hale, M.; Elford, AT.; Patel, C.; Hicks, L.; Kalyanji, S.; Dong, C.; Yeung, K.; Yeo, JH.; Allah-Ditta, M.; Bishara, M.; Sethi-Arora, K.; Pillay, L.; Johnston, EL.; Rudling, R.; Rees, F.; Harvey, P.; Trodden-Mittnacht, H.; Davis, E.; Fraser, A.; Sawan, NJ.; Hussain, MA.; Campbell, R.; George, B.; Rawcliffe, M.; Choon, XY.; Shah, K.; Al-Zarrad, D.; Toft, J.; Chhabra, P.; Burr, N.; Hewitt, A.; Kumar, R.; McCartney, S.; Rosiou, K.; Dhar, A.; Lees, CW.; Lamb, CA.; Speight, A.; Ahmad, T.; Limdi, J.; Raine, T.; Walsh, A.; Cooney, R.; Harrow, P.; Patel, K.; Samaan, M.; Pavlidis, P.; Kent, A.; Selinger, C.; Kok, KB.

Is 2nd JAKi treatment for UC worth the effort? A retrospective, multi-centre UK study.

All Authors

Radia, C.

Danso, Y.

Ritchie, S.

Hale, M.

Elford, AT.

Patel, C.

Hicks, L.

Kalyanji, S.

Dong, C.

Yeung, K.

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LTHT Author

Rosiou, Konstantina
Selinger, Christian

LTHT Department

Abdominal Medicine & Surgery
Gastroenterology

Publication Date

2025

Item Type

Journal Article
Multicenter Study

Abstract

BACKGROUND AND AIMS: Janus kinase inhibitors (JAKi) provide effective treatment for ulcerative colitis (UC), but inadequate response (IR) or intolerance occurs frequently. This study aimed to assess the effectiveness of a second JAKi in a real-world UC cohort. METHODS: A retrospective multicenter cohort study encompassing 19 UK hospitals was undertaken. Primary outcome was clinical remission (Simple Clinical Colitis Activity Index/partial Mayo Score <= 1) at weeks 8 and 24, based on available assessments. Biochemical (CRP <= 5mg/L and fecal calprotectin <= 200microg/g) and endoscopic (Ulcerative Colitis Endoscopic Index of Severity/Mayo Endoscopic Subscore <= 1) remission were also assessed. RESULTS: A total of 131 patients with active UC were included. The majority (60%) had exposure to >=3 advanced therapies and 50% required corticosteroids at induction. Clinical remission rates were 59% and 51% at weeks 8 and 24. Biochemical and endoscopic remission rates were 61% and 60% at week 8, and 47% and 32% at week 24. All disease activity parameters significantly reduced by week 8 (P < .001). At week 24 no difference was detected in clinical remission rates between those with primary non-response (42%) or secondary loss of response (52%) to their first JAKi (P = .518). Clinical remission did not differ between upadacitinib (54%) and filgotinib (36%), P = .253. Adverse events occurred in 27% of patients, and serious adverse events in 8%. CONCLUSIONS: In this highly refractory cohort with active UC a second JAKi effectively achieved remission following IR to first JAKi. Type of first JAKi failure did not appear to influence clinical remission. No new safety signals were found.