A RECENT retrospective cohort study comparing the effectiveness of upadacitinib and tofacitinib in patients with ulcerative colitis (UC) has shown that upadacitinib may lead to better disease-specific outcomes at 12 months.
The authors used the TriNetX multi-institutional database to compare the effectiveness of upadacitinib and tofacitinib in patients with UC (526 patients in the upadacitinib cohort; 1,149 patients in the tofacitinib cohort). The primary outcome was to assess the risk of a composite outcome requiring hospitalisation with intravenous steroids or colectomy within 6 and 12 months of treatment.
After matching for variables such as demographics, comorbid conditions, and prior UC medications, the results indicated no significant difference in the risk of the composite outcome within 6 months (adjusted odds ratio [aOR]: 0.75, 95% CI: 0.49–1.09). However, at 12 months, patients in the upadacitinib cohort had a significantly lower risk of the composite outcome compared to those in the tofacitinib cohort (aOR: 0.63, 95% CI: 0.44–0.89).
The study further revealed that, although there was no significant difference in the use of intravenous steroids between the two groups (aOR: 0.70, 95% CI: 0.48–1.02), upadacitinib was associated with a lower risk of colectomy (aOR: 0.46, 95% CI: 0.27–0.79). Sensitivity analysis confirmed these findings, showing a lower risk of the composite outcome (aOR: 0.64, 95% CI: 0.44–0.94) and lower risks of both intravenous steroid use (aOR: 0.67, 95% CI: 0.45–0.99) and colectomy (aOR: 0.49, 95% CI: 0.26–0.92) in the upadacitinib cohort compared to tofacitinib over 12 months.
These results suggest that upadacitinib may offer superior disease management for patients with UC, particularly by reducing the need for colectomy and intravenous steroids. This real-world evidence could guide clinicians in making more informed decisions regarding treatment options for UC patients.
Ada Enesco, EMJ
Reference
Kochhar GS et al. Comparative effectiveness of upadacitinib and tofacitinib in ulcerative colitis: a US propensity-matched cohort study. Am J Gastroenterol. 2024;119(12):2471-2479.
