Ellington AL, Rambuss D, Barbina S, Chitnavis M. Clinical outcomes of upadacitinib dose escalation in inflammatory bowel disease: A single-center retrospective cohort study. World J Gastrointest Pharmacol Ther 2026; 17(2): 120059 [DOI: 10.4292/wjgpt.v17.i2.120059]
Corresponding Author of This Article
Abigail Layton Ellington, MD, Internal Medicine, Atrium Health Wake Forest Baptist, 1 Medical Center Blvd, Winston-Salem, NC 27157, United States. abigail.ellington@advocatehealth.org
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Pharmacol Ther. Jun 5, 2026; 17(2): 120059 Published online Jun 5, 2026. doi: 10.4292/wjgpt.v17.i2.120059
Clinical outcomes of upadacitinib dose escalation in inflammatory bowel disease: A single-center retrospective cohort study
Abigail Layton Ellington, Danielle Rambuss, Sarah Barbina, Maithili Chitnavis
Abigail Layton Ellington, Danielle Rambuss, Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, United States
Sarah Barbina, Department of Gastroenterology, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, United States
Maithili Chitnavis, Department of Gastroenterology, Atrium Health Carolinas Medical Center, Charlotte, NC 28203, United States
Author contributions: Ellington AL, Chitnavis M, and Barbina S designed the research study; Ellington AL and Rambuss D collected the data; Ellington AL analyzed and interpreted the data; Ellington AL drafted the manuscript; Rambuss D and Barbina S contributed to data interpretation and critical revision of the manuscript for important intellectual content; Chitnavis M contributed to study supervision and critical revision of the manuscript for important intellectual content; all authors reviewed and approved the final version of the manuscript.
Institutional review board statement: This study was approved by the Atrium Health Wake Forest Baptist Institutional Review Board (No. 00125815).
Informed consent statement: No signed informed consent forms were obtained, as the requirement for informed consent was formally waived by the Institutional Review Board in accordance with institutional policies and applicable ethical standards.
Conflict-of-interest statement: Chitnavis MV has received consulting and speaker fees from AbbVie and speaking fees from Janssen and Eli Lilly. The other authors declare no financial disclosures or conflicts of interest.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: The datasets generated and/or analyzed during the current study are not publicly available due to patient privacy considerations but are available from the corresponding author on reasonable request.
Corresponding author: Abigail Layton Ellington, MD, Internal Medicine, Atrium Health Wake Forest Baptist, 1 Medical Center Blvd, Winston-Salem, NC 27157, United States. abigail.ellington@advocatehealth.org
Received: February 14, 2026 Revised: March 10, 2026 Accepted: April 15, 2026 Published online: June 5, 2026 Processing time: 103 Days and 4.5 Hours
Abstract
BACKGROUND
Upadacitinib is a selective Janus kinase-1 (JAK1) inhibitor approved for the treatment of moderate-to-severe ulcerative colitis (UC) and Crohn’s disease (CD). Standard therapy consists of induction dosing at 45 mg daily followed by maintenance dosing of 15-30 mg daily. Although pivotal trials demonstrated sustained efficacy with maintenance therapy, secondary loss of response occurs in clinical practice. Data regarding the effectiveness of dose re-escalation remain limited.
AIM
To evaluate clinical outcomes following upadacitinib dose escalation in inflammatory bowel disease (IBD) with loss of response to maintenance dosing.
METHODS
We conducted a single-center retrospective cohort study of adults with IBD who underwent re-escalation to upadacitinib 45 mg daily beyond the labeled induction period. Data were obtained through electronic medical record review. The primary endpoint was clinical response, defined as provider-documented symptom improvement and/or objective improvement in biomarkers or endoscopic assessment. Secondary outcomes included indications for escalation, corticosteroid exposure, IBD-related healthcare utilization, and treatment durability.
RESULTS
A total of 56 patients were included [38 CD, 18 UC; median age 34 years (interquartile range: 26-46), 43% female] with a mean of 2.49 prior biologic exposures. Among 49 patients with paired symptom data, abdominal pain decreased from 57% to 29% (P = 0.003), hematochezia from 49% to 20% (P = 0.004), urgency from 45% to 16% (P = 0.003), and diarrhea from 55% to 37% (P = 0.049). Corticosteroid use declined from 50% to 32% (P = 0.031). The proportion with ≥ 1 IBD-related hospitalization or emergency department visit decreased from 32% to 20%. Biomarkers and endoscopic outcomes improved numerically but were limited by small paired samples. At most recent follow-up, 89% of patients remained on escalated dosing.
CONCLUSION
In this single-center cohort, upadacitinib dose escalation improves symptoms and reduces corticosteroid use, supporting dose intensification as a pragmatic strategy for secondary loss of response.
Core Tip: Real-world data guiding dose re-escalation of upadacitinib in inflammatory bowel disease (IBD) are limited. In this single-center cohort, off-label intensification in patients with secondary loss of response was associated with significant symptomatic improvement and reduced corticosteroid exposure, with favorable trends in objective measures. Most patients remained on the escalated dose at follow-up. No new laboratory safety signals were observed. These findings suggest dose intensification may represent a pragmatic management strategy in selected patients with IBD.
