Clin Gastroenterol Hepatol

Upadacitinib reinduction restores remission in real-world IBD cohort

August 18, 2025

In real-world practice, most IBD patients who lose response to upadacitinib after dose reduction can recapture and maintain remission with reinduction and continued high-dose (45 mg daily) therapy. This approach appears effective and safe, supporting consideration of sustained high-dose maintenance in select patients with recurrent loss of response.

Study details: This prospective cohort study evaluated adults with IBD (Crohn’s disease, ulcerative colitis, IBD-unclassified, and ileal pouch-anal anastomosis [IPAA]) who initially responded to upadacitinib 45 mg daily induction, then lost response after transitioning to lower maintenance doses (primarily 30 mg daily). Patients underwent reinduction with upadacitinib 45 mg daily, with clinical, biochemical, radiologic, and endoscopic outcomes assessed over a median follow-up of 93 weeks.

Results: Among 181 initial responders, 46 experienced loss of response after dose reduction. Median time to relapse was 21 weeks post-dose reduction. Reinduction with 45 mg daily recaptured clinical response in 80.4% of patients. Of those who recaptured response, 19 attempted another dose reduction; sustained remission was significantly higher in those maintained on 45 mg daily (93.8%) vs. those reduced to 30 mg (21.1%, p<0.001). Disease extent and duration didn't predict recapture. Acne/rosacea was the most common adverse event (39%); no serious adverse events were reported.

Source:

Ho AH, et al. (2025, August 7). Clin Gastroenterol Hepatol. Real-World Experience of Upadacitinib Reinduction and High Dose Maintenance Therapy in Inflammatory Bowel Disease. https://pubmed.ncbi.nlm.nih.gov/40782945/