P2240 - Upadacitinib - A Treatment Alternative for Severe Ulcerative Colitis in the Hospital

Curuchi Anand, MD¹, Shiv Gandhi, MD^2
1Saint Vincent Hospital, Worcester, MA; ²University of Massachusetts Medical Center, Worcester, MA

Introduction: The treatment of severe ulcerative colitis in a hospital setting is aimed at rapidly controlling inflammation, resolving symptoms and preventing complications. It involves intravenous corticosteroids and addition of biologic agents or cyclosporine. Due to high cost and lack of reimbursement for the medication in inpatient setting, access to biologics is restricted for inpatient use especially in community hospitals. Upadacitinib is an oral JAK inhibitor approved for treatment of moderate to severe ulcerative colitis in adult TNFi-IR patients. It has been shown to provide rapid clinical response and can be considered for treating patients hospitalized with severe ulcerative colitis. However, there is lack of data about its use in this setting. We present two patients admitted with severe ulcerative colitis, treated with Upadacitinib in hospital.

Case Description/Methods: 54 year old male with ulcerative pancolitis diagnosed in 2018. Controlled on Infliximab until 3 months prior to admission. Failed oral prednisone and mesalamine, adequate Infliximab trough level and no antibodies. Hospitalized with 20-30 bloody stools a day. WBC 17, hemoglobin 12, CRP 36. Stool culture and c-difficle negative. No colonic dilatation. Limited colonoscopy showed severe colitis with ulcers and bleeding. Mayo score 11. Started intravenous methylprednisolone day 1, added Upadacitinib 45 mg orally day 2. Stool frequency and bleeding improved by day 4, to 6 /day, had 1 stool without blood at discharge on day 5. At 4 week follow up switched to Upadacitinib 30 mg daily and tapered off steroids. Had mild symptoms, stools 3-4 / day with occasional blood.
48 year old male with ulcerative pancolitis diagnosed in 2010. Was on Adalimumab, stopped in 2014 due to side effects. Controlled on mesalamine until admission with severe symptoms. Mayo score 10. CRP 24. Bowel frequency 15-20 per day, most with blood. Sigmoidoscopy showed severe proctosigmoiditis. Biopsy confirmed severe active colitis. Treated with intravenous methylprednisolone and Upadacitinib 45 mg. Improved by day 4 and discharged with Upadacitinib. In clinical remission 6 month post discharge on Upadacitinib 15 mg and mesalamine.

Discussion: Upadacitinib can be considered for inpatient treatment of severe ulcerative colitis together with intravenous corticosteroids. However, clinical trials to study use in this population is required. There may be a significant cost advantage to the hospital compared to biologics in the inpatient setting.


Disclosures:


Curuchi Anand, MD¹, Shiv Gandhi, MD². P2240 - Upadacitinib - A Treatment Alternative for Severe Ulcerative Colitis in the Hospital, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.