Abstract：
BACKGROUND: Inflammatory bowel disease is a chronic, relapsing, and remitting inflammatory disorder that despite advances in medical therapy often requires hospitalization for treatment of acute flares with intravenous corticosteroids. Many patients will not respond to corticosteroids and require infliximab or cyclosporine as rescue therapy. If medical therapy fails, definitive surgical management is required. Recently, Janus Kinase inhibitors, including upadacitinib, have been proposed as an alternative rescue therapy.
OBJECTIVE: We hypothesized that upadacitinib may be effective in treating acute severe colitis.
METHODS: A retrospective review of 12 inflammatory bowel disease patients admitted for acute severe colitis who received upadacitinib induction therapy was performed. The rates of surgery, repeat or prolonged steroid use, and re-admission within 90 days of index hospitalization were measured. The need for re-induction with upadacitinib, change in medical therapy, rates of clinical remission, change in 6-point partial Mayo score, and laboratory markers of inflammation were measured as secondary outcomes.
RESULTS: Five patients met the primary composite endpoint including four patients requiring surgery and one additional patient being unable to withdraw steroids within 90 days of hospital discharge. One patient required re-induction with upadacitinib within 90 days and no patients required change in medical therapy within 90 days. Most patients who did not undergo surgery were in clinical remission within 90 days and showed clinical improvement with decreased 6-point partial Mayo scores.
CONCLUSIONS: Upadacitinib may be effective salvage therapy for acute severe colitis, but larger controlled trials are required to validate these results.
OBJECTIVE: We hypothesized that upadacitinib may be effective in treating acute severe colitis.
METHODS: A retrospective review of 12 inflammatory bowel disease patients admitted for acute severe colitis who received upadacitinib induction therapy was performed. The rates of surgery, repeat or prolonged steroid use, and re-admission within 90 days of index hospitalization were measured. The need for re-induction with upadacitinib, change in medical therapy, rates of clinical remission, change in 6-point partial Mayo score, and laboratory markers of inflammation were measured as secondary outcomes.
RESULTS: Five patients met the primary composite endpoint including four patients requiring surgery and one additional patient being unable to withdraw steroids within 90 days of hospital discharge. One patient required re-induction with upadacitinib within 90 days and no patients required change in medical therapy within 90 days. Most patients who did not undergo surgery were in clinical remission within 90 days and showed clinical improvement with decreased 6-point partial Mayo scores.
CONCLUSIONS: Upadacitinib may be effective salvage therapy for acute severe colitis, but larger controlled trials are required to validate these results.
摘要：
背景：炎症性肠病是一种慢性，复发，和缓解炎症性疾病，尽管在药物治疗方面取得了进展，但通常需要住院治疗，以静脉注射皮质类固醇治疗急性耀斑。许多患者对皮质类固醇无反应，需要英夫利昔单抗或环孢素作为抢救治疗。如果药物治疗失败,需要明确的手术管理。最近,Janus激酶抑制剂,包括upadacitinib,已被提议作为替代抢救疗法。
目的：我们假设upadacitinib可能有效治疗急性重度结肠炎。
方法：对接受upadacitinib诱导治疗的12例因急性重度结肠炎入院的炎症性肠病患者进行回顾性分析。手术率，重复或长期使用类固醇，并在住院90天内再次入院。需要用upadacitinib重新诱导，改变药物治疗，临床缓解率，梅奥6分部分得分的变化，和实验室炎症标志物作为次要结局.
结果：5例患者达到了主要复合终点，其中4例需要手术治疗，另外1例患者在出院后90天内不能停用类固醇。一名患者需要在90天内使用upadacitinib重新诱导，90天内没有患者需要改变药物治疗。大多数未接受手术的患者在90天内临床缓解，并显示出临床改善，部分Mayo评分降低了6分。
结论：Upadacitinib可能是治疗急性重度结肠炎的有效挽救性治疗，但需要更大的对照试验来验证这些结果.
目的：我们假设upadacitinib可能有效治疗急性重度结肠炎。
方法：对接受upadacitinib诱导治疗的12例因急性重度结肠炎入院的炎症性肠病患者进行回顾性分析。手术率，重复或长期使用类固醇，并在住院90天内再次入院。需要用upadacitinib重新诱导，改变药物治疗，临床缓解率，梅奥6分部分得分的变化，和实验室炎症标志物作为次要结局.
结果：5例患者达到了主要复合终点，其中4例需要手术治疗，另外1例患者在出院后90天内不能停用类固醇。一名患者需要在90天内使用upadacitinib重新诱导，90天内没有患者需要改变药物治疗。大多数未接受手术的患者在90天内临床缓解，并显示出临床改善，部分Mayo评分降低了6分。
结论：Upadacitinib可能是治疗急性重度结肠炎的有效挽救性治疗，但需要更大的对照试验来验证这些结果.
