{
  "abstract": "Introduction Upadacitinib is an oral, selective Janus Kinase 1 (JAK1) inhibitor approved for induction and maintenance of remission in moderate-to-severe Inflammatory Bowel Disease (IBD). Although clinical trials have established its efficacy and safety, real-world practice often diverges from the protocolised regimen. 1 2 In patients with secondary loss of response, dose escalation strategies can be considered, but supporting evidence remains limited.Methods We conducted a retrospective cohort study of adults with Crohn’s disease (CD) and ulcerative colitis (UC) who received upadacitinib dose escalation at our hospital between January 2023 and June 2025. The study aims to evaluate the effectiveness and safety of upadacitinib dose escalation. Patients were included if they had completed at least 8 weeks of induction at 45mg daily, were subsequently stepped down to a maintenance dose of 15mg or 30mg daily and were later re-escalated to 45mg daily due to worsening clinical symptoms and/or biochemical evidence of inflammation.Results Seventeen patients (11 with CD and 6 with UC) underwent upadacitinib dose escalation. 54.5% (n=6) of CD and 66.6% (n=4) of UC patients responded to dose escalation. 36.6% of CD patients and 50% of UC patients subsequently de-escalated to maintenance dosing. Dose escalation was used for secondary loss of response after multiple previous advanced therapies (82%) or when surgery was declined (5%). Corticosteroid use decreased from 47% (n=8) to 29% (n=5) after dose escalation. Dose escalation improved clinical disease activity indices and inflammatory markers ( table 1). Adverse events included infections (n=9), with four hospitalised for infection-related illness, and five occurred while receiving corticosteroids. Hepatic dysfunction, abdominal pain, elevated creatine kinase, acne, and iron deficiency anaemia were less common. No patient discontinued upadacitinib due to adverse events except for one individual because of acne. No venous thromboembolism, malignancy, or death were observed.Conclusions Upadacitinib dose escalation was effective for a proportion of patients who experienced secondary loss of response, with over half able to remain on upadacitinib. Improvements were seen across clinical and biochemical markers. Larger studies are required to clarify which patients are most likely to respond to dose escalation.References Danese S, et al. Upadacitinib for UC: phase 3 trials. Lancet. 2022;399:2113–28.Johnson AM, et al. Real-world ustekinumab in crohn’s disease (SUCCESS). Am J Gastroenterol. 2023;118:317–28.Abstract P254 Table 1BeforeAfterMedian time on dose escalation, days149 days (range 55 – 402)Median Harvey-Bradshaw index for CD (SD)6 ± 2.65 ± 2.9Median partial Mayo score for UC (SD)6 ± 1.33 ± 1.4Median C-reactive protein, mg/L72Median faecal calprotectin, ug/g591181",
  "authors": [
    {
      "affiliations": [
        "Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Kai Wen Chen"
    },
    {
      "affiliations": [
        "Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Mohammad Al-Ajalein"
    },
    {
      "affiliations": [
        "Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Peter Rimmer"
    },
    {
      "affiliations": [
        "Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Syazeddy Samani"
    },
    {
      "affiliations": [
        "Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom",
        "NIHR Birmingham Biomedical Research Centre, Birmingham, United Kingdom",
        "University of Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Rachel Cooney"
    }
  ],
  "title": "P254 Real-world outcomes of upadacitinib dose escalation in inflammatory bowel disease",
  "uid": "8131cd0d-da76-5709-bd7b-39b62641ce84"
}