Retrospective multicenter study (9 centers, n=312) comparing upadacitinib, tofacitinib, and ustekinumab in bio-exposed UC patients who had failed ≥1 advanced therapy, assessed at weeks 16 and 52 for steroid-free clinical remission (SFCR) and endoscopic remission.
After propensity score-weighted analysis, upadacitinib had higher SFCR odds vs. tofacitinib (w16: OR 2.56; w52: OR 3.14) and ustekinumab (w16: OR 3.71; w52: OR 4.68). Endoscopic remission rates at w52 were 56.8% (upadacitinib) vs. 32.7% (tofacitinib) vs. 22.5% (ustekinumab), with upadacitinib outperforming both at both timepoints.
Retrospective design with inherent selection bias; IPTW mitigates but does not eliminate confounding; single-country or limited-center generalizability not specified, and small subgroup sizes (tofacitinib n=74) may limit precision of estimates.
In UC patients who have failed a prior biologic, upadacitinib achieves meaningfully higher rates of steroid-free clinical and endoscopic remission than either tofacitinib or ustekinumab at both 16 and 52 weeks. Clinicians should prioritize upadacitinib when selecting a second-line advanced therapy in this population.
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