Upadacitinib Is Associated with the Lowest Risk of Treatment Failure Among Advanced Therapies for Ulcerative Colitis: A Real-World Administrative Claims Study.

IF 16.2 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology Pub Date : 2026-09-29 DOI:10.1016/j.cgh.2026.09.020

Marianne Hupé, Dhruv Ahuja, Kuan-Hung Yeh, Sagar B Patel, Ronghui Xu, Sudheer Kumar Vuyyuru, Anna Silverman, Ashwin N Ananthakrishnan, Ola Olén, Shane W Goodwin, Vipul Jairath, Siddharth Singh

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引用次数: 0

Abstract

Background and aims: We compared the real-world effectiveness of advanced therapies (AT) in patients with ulcerative colitis (UC).

Methods: Using the OptumLabs® Data Warehouse, a nationally representative US administrative claims database, we identified patients with UC initiating infliximab, adalimumab, vedolizumab, ustekinumab, tofacitinib, or upadacitinib between 2016 and 2023. The primary outcome was time to treatment failure (composite of IBD-related hospitalization, IBD-related surgery, or new corticosteroid prescription occurring >90 days after index date); treatment discontinuation and switching were treated as censoring events. The secondary outcome was proportion of quarters in corticosteroid-free disease stability. Confounding was addressed using multinomial propensity score-based inverse probability weighting with generalized boosted models and competing risk adjustment for mortality.

Results: We identified 7,283 patients contributing 9,078 treatment episodes with initiation of infliximab (n=1,624), adalimumab (n=2,315), vedolizumab (n=3,164), ustekinumab (n=1,274), tofacitinib (n=547), or upadacitinib (n=154). After IPW adjustment, upadacitinib was associated with significantly lower risk of treatment failure compared with infliximab (HR 0.61 [95% CI, 0.42-0.88]), adalimumab (HR 0.59 [0.41-0.86]), vedolizumab (HR 0.69 [0.48-1.00]), ustekinumab (HR 0.65 [0.45-0.95]), and tofacitinib (HR 0.59 [0.40-0.88]). Vedolizumab was associated with lower risk of treatment failure compared with infliximab (HR 0.88 [0.79-0.98]) and adalimumab (HR 0.86 [0.78-0.95]). Upadacitinib had the highest adjusted proportion of quarters in corticosteroid-free disease stability (0.70 [0.63-0.77]). Findings were consistent in patients with and without prior AT exposure.

Conclusions: In this large real-world UC cohort, upadacitinib was associated with the lowest risk of treatment failure and greatest corticosteroid-free disease stability compared with all other ATs evaluated.

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在溃疡性结肠炎的先进疗法中，Upadacitinib与治疗失败风险最低相关：一项真实世界的行政索赔研究

背景和目的：我们比较了先进疗法（AT）在溃疡性结肠炎（UC）患者中的实际疗效。方法：使用OptumLabs®数据仓库（一个具有全国代表性的美国行政索赔数据库），我们确定了2016年至2023年间使用英夫利昔单抗、阿达木单抗、维多单抗、乌斯特金单抗、托法替尼或upadacitinib的UC患者。主要终点是治疗失败的时间（综合ibd相关住院、ibd相关手术或在指标日期后90天内出现新的皮质类固醇处方）；治疗中断和切换被视为审查事件。次要结局是无皮质类固醇疾病稳定性的四分之一的比例。使用基于广义增强模型的多项倾向得分逆概率加权和死亡率的竞争风险调整来解决混淆问题。结果：我们确定了7283例患者，包括英夫利昔单抗（n= 1624）、阿达木单抗（n= 2315）、维多单抗（n= 3164）、乌斯特金单抗（n= 1274）、托法替尼（n=547）或upadacitinib (n=154)，共9078次治疗。调整IPW后，upadacitinib与英夫利昔单抗（HR 0.61 [95% CI, 0.42-0.88]）、阿达木单抗（HR 0.59[0.41-0.86]）、vedolizumab （HR 0.69[0.48-1.00]）、ustekinumab （HR 0.65[0.45-0.95]）和tofacitinib （HR 0.59[0.40-0.88]）相比，治疗失败的风险显著降低。与英夫利昔单抗（HR 0.88[0.79-0.98]）和阿达木单抗（HR 0.86[0.78-0.95]）相比，Vedolizumab的治疗失败风险较低。Upadacitinib在无皮质类固醇疾病稳定性方面的调整比例最高（0.70[0.63-0.77]）。研究结果在有或没有AT暴露的患者中是一致的。结论：在这个庞大的现实世界UC队列中，与所有评估的其他ATs相比，upadacitinib与最低的治疗失败风险和最高的无皮质类固醇疾病稳定性相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Gastroenterology and Hepatology 医学-胃肠肝病学

CiteScore

16.90

自引率

4.80%

发文量

903

审稿时长

22 days

期刊介绍： Clinical Gastroenterology and Hepatology (CGH) is dedicated to offering readers a comprehensive exploration of themes in clinical gastroenterology and hepatology. Encompassing diagnostic, endoscopic, interventional, and therapeutic advances, the journal covers areas such as cancer, inflammatory diseases, functional gastrointestinal disorders, nutrition, absorption, and secretion. As a peer-reviewed publication, CGH features original articles and scholarly reviews, ensuring immediate relevance to the practice of gastroenterology and hepatology. Beyond peer-reviewed content, the journal includes invited key reviews and articles on endoscopy/practice-based technology, health-care policy, and practice management. Multimedia elements, including images, video abstracts, and podcasts, enhance the reader's experience. CGH remains actively engaged with its audience through updates and commentary shared via platforms such as Facebook and Twitter.