Upadacitinib in refractory ulcerative colitis patients with high thromboembolic risk: two case reports

Upadacitinib is a novel selective Janus kinase (JAK) inhibitor approved for adults with ulcerative colitis (UC). While caution is advised when considering upadacitinib as a treatment option for patients with an increased risk of thrombosis. The current case report describes two UC patients with high thromboembolic risk successfully treated with upadacitinib and rivaroxaban. The two patients reported increased stool frequency, decreased stool consistency, abdominal pain and hematochezia, both of whom had experienced mesalazine, corticosteroids, vedolizumab and infliximab, all failed to induce clinical remission. The male patient had a history of deep vein thrombosis (DVT) in his left lower limb, and the female patient had thrombophlebitis in a branch of the cephalic vein on the left forearm. After multidisciplinary conference and thorough informed consent, upadacitinib and rivaroxaban were applied. Two months after the initiation of treatment, the patients' symptoms and endoscopic findings improved significantly. No thromboembolic events or other adverse effects have been observed to date. Our case report suggests that concurrent use of anticoagulation with upadacitinib may represent a safe and valuable strategy for treating refractory UC with high thromboembolic risk.