S1501 Real-World Switch Rates, Adherence, and Corticosteroid Use Among Tumor Necrosis Factor Inhibitor-Experienced Patients With UC Initiating Upadacitinib Relative to Those Initiating Ustekinumab, Vedolizumab, and Tofacitinib

Introduction: Ulcerative colitis (UC) is a chronic relapsing and remitting inflammatory gastrointestinal disease. Upadacitinib (UPA) is an oral Janus Kinase (JAK) inhibitor approved for UC in 2022. Chronic corticosteroid (CS) use and low rates of adherence have been linked to substantial clinical and economic burden. Understanding treatment patterns can provide insights into the response and tolerability of different treatment options to optimize clinical decision making. This study describes real-world CS use, switch rates, and adherence among tumor necrosis factor inhibitor (TNFi)-experienced UC patients initiating UPA relative to those initiating ustekinumab (UST), vedolizumab (VED), and tofacitinib (TOF). Methods: This retrospective cohort study of TNFi-experienced UC patients initiating a new advanced therapy used US healthcare claims data from the Merative™ MarketScan® database from Jan 2022 to Dec 2024. Initiators of UPA, UST, VED, and TOF with prior TNFi use were included. CS use (stratified by quarter), switch rates, and adherence (defined by proportion of days covered ≥80%) were evaluated at 12 months. Results were calculated using logistic regression adjusting for age, gender, region, Charlson Comorbidity Index, insurance type, year of index date, prior lines of therapy, and baseline healthcare resource use. Results: Of 1051 patients who met the inclusion criteria, 256 initiated with UPA, 425 with UST, 321 with VED, and 49 with TOF. Mean age was 41 years and ∼40% of patients had ≥2 prior lines of therapy. After adjustment, patients treated with UPA had the lowest rate of CS use during the 4th quarter of treatment vs other advanced therapies (UPA: 19.9%, UST: 28.9%, VED: 27.4%, TOF: 28.6%); results for UST vs UPA were statistically significant (OR 1.61 [95% CI: 1.09, 2.37]; P < 0.05). UPA and UST had the lowest switch rates, 15.6% and 15.1%, respectively, at 12 months. Results were statistically significant for TOF vs UPA (OR 3.56 [95% CI: 1.78, 7.12]; P < 0.001). Adherence to UPA was comparable to UST and VED (UPA: 69.9%, UST 70.4%, VED: 72.3%, TOF: 51.0%), despite being an oral agent and was significantly higher compared to TOF (OR 0.43 [95% CI: 0.23, 0.83], P < 0.01). Conclusion: This retrospective real-world claim analysis demonstrated that UPA was effective in a real-world TNFi-experienced population with the lowest risk of switching and lowest rate of CS use among all other advanced therapies in 1 year of follow-up.