P4292 - Real World Efficacy and Safety Outcomes Analysis of Upadacitinib in Acute Severe Ulcerative Colitis: A Propensity Score Matched Comparative Effectiveness Study Assessing Infliximab & Upadacitinib

Tushar Khanna, MD¹, Priya Sehgal, MD¹, Aakash Desai, MD², Emad Mansoor, MD³, Gary Lichtenstein, MD^1
1Penn Medicine, Philadelphia, PA; ²Mayo Clinic, Pittsburgh, PA; ³Digestive Health Institute, University Hospitals Cleveland Medical Center, Cleveland, OH

Introduction: Upadacitinib (Upa), a selective Janus kinase 1 (JAK1) inhibitor, has shown promise in treating moderate to severe UC. However, limited real world efficacy & safety data are available for its use in patients with Acute Severe Ulcerative Colitis (ASUC). This study aims to evaluate real-world efficacy & safety outcomes of Upa compared to infliximab (IFX) in hospitalized UC patients.

Methods: This retrospective cohort study used data from the TriNetX platform, comprising 64 healthcare organizations within the US Collaborative Network including 130 million patients. Two cohorts were identified: patients with ASUC treated with IFX (Cohort 1, n=3466) & ASUC patients treated with Upa (Cohort 2, n=178). Primary exposure was defined as the first occurrence of either treatment, with outcomes measured over a five-year period post-exposure. One to one propensity score matching (PSM) balanced baseline characteristics between the cohorts including age, gender, race, laboratory values & comorbid conditions. Primary outcome analyzed was incidence of colectomy & secondary outcomes included rates of transfusion, IV steroid use, colon perforation, rectal bleeding and infection.

Results: The IFX group consisted of 3,466 patients & the Upa group consisted of 180 patients before PSM. After PSM, 177 patients were included in each cohort. Notably more patients in the Upa group were previously treated with Adalimumab(20.3%) & Ustekinumab (25.4%); p< 0.001 with 44.1% of patients also previously on Infliximab . No significant difference was found in colectomy rates between the two cohorts. Furthermore, no significant differences were found regarding future steroid use or rectal bleeding. A decreased incidence of colon perforation was noted in the Upa group compared to the IFX group (p=0.001). Adverse events were also comparable in both groups as was the incidence of mortality (Table 1).

Discussion: Upadacitinib demonstrates comparable efficacy & safety to infliximab in real-world hospitalized UC patients. While there was no significant difference observed with regard to colectomy rates, it was interesting to note a decreased rate of colonic perforation in the Upa group compared to IFX. These findings support the use of Upa as a viable alternative to infliximab for UC treatment, with consideration for individualized patient risk factors.


Disclosures:


Tushar Khanna, MD¹, Priya Sehgal, MD¹, Aakash Desai, MD², Emad Mansoor, MD³, Gary Lichtenstein, MD¹. P4292 - Real World Efficacy and Safety Outcomes Analysis of Upadacitinib in Acute Severe Ulcerative Colitis: A Propensity Score Matched Comparative Effectiveness Study Assessing Infliximab & Upadacitinib, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.