{
  "abstract": "Upadacitinib is a selective Janus kinase-1 inhibitor with proven efficacy in adults with moderate to severe ulcerative colitis and Crohn’s disease. Paediatric use remains off-label, largely due to delays in paediatric approvals, and real-world data are needed to better understand its effectiveness and safety profile in children with inflammatory bowel disease.A retrospective case series was undertaken, including children aged 6–16 years with inflammatory bowel disease who were treated with upadacitinib following failure of anti-tumour necrosis factor therapy. Post-induction steroid-free clinical remission, as determined by the treating clinicians, requirement for surgery, and adverse events were assessed up to the last follow-up.Nineteen children were included (12 Crohn’s disease, 3 ulcerative colitis, 4 inflammatory bowel disease-unclassified), of whom 52% were male, with a median age of 12 years. Sixty-three per cent had been exposed to two or more biologic therapies before treatment. All patients received upadacitinib as monotherapy for at least 12 weeks, with a median treatment duration of 35 weeks (interquartile range 14.8–55.3). Steroid-free clinical remission at week 12 was achieved in 68% (13/19) of patients, and all responders remained in remission at last follow-up. Five patients who did not respond required surgical intervention, including colectomy (n=3), right hemicolectomy (n=1), and ileocaecal resection (n=1). One patient was subsequently recommenced on upadacitinib following surgery. Adverse events were reported in two patients and included recurrent oral ulceration and shingles.Upadacitinib appears to be a promising treatment option for children with refractory inflammatory bowel disease following biologic failure. Its oral administration offers a practical advantage by avoiding injections or hospital-based intravenous infusions, which may be particularly appealing in paediatric practice. Larger multicentre studies with longer follow-up are required to further evaluate efficacy and confirm the safety profile in this population.References Sandborn WJ, Feagan BG, D’Haens G. Upadacitinib as induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2022;386:2373–84.Vermeire S, Schreiber S, Petryka R. Clinical remission in Crohn’s disease with upadacitinib. Lancet 2020;395:2015–24.Turner D, Ruemmele FM, Orlanski-Meyer E. Management of paediatric ulcerative colitis. J Pediatr Gastroenterol Nutr. 2018;67:257–91.Levine A, Koletzko S, Turner D. ESPGHAN revised porto criteria for inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2014;58:795–806.",
  "authors": [
    {
      "affiliations": [
        "Bristol Royal Hospital for Children"
      ],
      "name": "Kritika Sharma"
    },
    {
      "affiliations": [
        "Bristol Royal Hospital for Children"
      ],
      "name": "Akshatha Mallikarjuna"
    }
  ],
  "title": "LBA14 Single-centre experience with upadacitinib in children with anti-TNF failure inflammatory bowel disease",
  "uid": "e924ae25-352b-502e-845b-d81b8952ebe7"
}