Use of Upadacitinib in elderly patients with IBD: a case series

Upadacitinib (UPA) is a selective Janus kinase (JAK) 1 inhibitor that may rapidly induce and maintain a remission of inflammatory bowel disease (IBD) through potent suppression of cytokine signaling. While a pan-JAK inhibitor has been shown to increase the risk of thromboembolic and major cardiovascular events (MACE), especially in elderly patients with rheumatoid arthritis, UPA may potentially be a better therapeutic option for elderly IBD patients owing to its selective effect on JAK1. However, the usefulness of UPA in elderly IBD patients has yet to be well assessed. To explore the efficacy and safety of UPA in elderly IBD patients, we conducted a retrospective case series study of patients with ulcerative colitis (UC) and Crohn’s disease (CD) aged over 60 years who received UPA from December 2022 to March 2025. Clinical response and remission rates, incidence of adverse events, and clinical outcomes were analyzed. A total of 8 patients (5 UC and 3 CD) were included in this study. The rate of clinical response in UC was 40% at week 8, 80% at week 16, and the remission rate was 60% at week 16. One patient with acute severe UC underwent colectomy at week 3 due to resistance to UPA, although the patient had also failed a rescue therapy with infliximab (IFX). In patients with CD, the rate of clinical response and remission at week 12 was 33.3% each. After 52 weeks of treatment, 60% of UC and 66.7% of CD patients had sustained UPA treatment. During the median follow-up time of 14.1 months (95% CI 9.2, 24.4 months), adverse events of Common Terminology Criteria for Adverse Events (CTCAE) grade 2 or higher were identified in two cases. Although one patient with UC discontinued UPA at week 36 due to anemia and liver damage, most adverse events observed were otherwise mild. No serious infections, thromboembolic events, MACE, or malignancies were noted. While the small sample size precludes definitive conclusions, this case series suggests that UPA has potential efficacy and relatively acceptable tolerability in elderly patients with IBD.