Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 26, 2024; 12(9): 1685-1690
Published online Mar 26, 2024. doi: 10.12998/wjcc.v12.i9.1685
Upadacitinib for refractory ulcerative colitis with primary nonresponse to infliximab and vedolizumab: A case report
Xuan Xu, Jing-Wen Jiang, Bing-Yun Lu, Xia-Xi Li
Xuan Xu, Jing-Wen Jiang, Bing-Yun Lu, Xia-Xi Li, Department of Gastroenterology, Shenzhen Hospital, Southern Medical University, Shenzhen 518100, Guangdong Province, China
Xuan Xu, Jing-Wen Jiang, The First Clinical Medical School, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Co-first authors: Xuan Xu and Jing-Wen Jiang.
Author contributions: Xu X and Jiang JW drafted the original report; Li XX was involved in the revision of the report and supervised the report and provided the required resources; Xu X, Jiang JW and Li XX acquired data; Xu X interpreted images; Lu BY was involved in the patient’s care. All authors have read and agreed to the published version of the manuscript.
Supported by Shenzhen Science and Technology Program, No. JCYJ20220530154013031; Guangdong Province Health and Health Appropriate Technology Promotion Project, No. 2023385; and Guangdong Province Grassroots Science Popularization Action Plan, No. 20240205.
Informed consent statement: Informed consent was obtained from the patient for this case report.
Conflict-of-interest statement: The authors declare no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xia-Xi Li, PhD, Chief Doctor, Department of Gastroenterology, Shenzhen Hospital, Southern Medical University, No. 1333 Xinhu Road, Shenzhen 518100, Guangdong Province, China. xiaxi_li@foxmail.com
Received: December 20, 2023
Peer-review started: December 20, 2023
First decision: January 4, 2024
Revised: February 22, 2024
Accepted: February 28, 2024
Article in press: February 28, 2024
Published online: March 26, 2024
Processing time: 95 Days and 22.2 Hours
Abstract
BACKGROUND

Many patients with ulcerative colitis (UC) do not respond well to, or tolerate conventional and biological therapies. There is currently no consensus on the treatment of refractory UC. Studies have demonstrated that the selective Janus kinase 1 inhibitor upadacitinib, a small-molecule drug, is effective and safe for treating UC. However, no studies have revealed that upadacitinib is effective in treating refractory UC with primary nonresponse to infliximab and vedolizumab.

CASE SUMMARY

We report the case of a 44-year-old male patient with a chief complaint of bloody diarrhoea with mucus and pus, in addition to dizziness. The patient had recurrent disease after receiving mesalazine, prednisone, azathioprine, infliximab and vedolizumab over four years. Based on the endoscopic findings and pathological biopsy, the patient was diagnosed with refractory UC. In particular, the patient showed primary nonresponse to infliximab and vedolizumab. Based on the patient’s history and recurrent disease, we decided to administer upadacitinib. During hospitalisation, the patient was received upadacitinib under our guidance. Eight weeks after the initiation of upadacitinib treatment, the patient’s symptoms and endoscopic findings improved significantly. No notable adverse reactions have been reported to date.

CONCLUSION

Our case report suggests that upadacitinib may represent a valuable strategy for treating refractory UC with primary nonresponse.

Keywords: Upadacitinib; Refractory ulcerative colitis; Primary nonresponse; Infliximab; Vedolizumab; Case report

Core Tip: Ulcerative colitis (UC) is a major type of inflammatory bowel disease. Many patients do not respond well to the current therapies. We report the case of a patient diagnosed with refractory UC, with primary nonresponse to infliximab and vedolizumab. The patient experienced recurrent symptoms after receiving mesalazine, prednisone, azathioprine, infliximab, and vedolizumab for more than four years. After optimising the upadacitinib treatment, UC remission was achieved. Our report suggests that the small-molecule upadacitinib may be a new treatment option that deserves to be reported and studied.