Hongzhen Wu,1– 3,* Yi Lu,4,* Yun Su,1– 3,* Tao Su,1– 3 Min Zhang,1– 3 Min Zhi,1– 3 Jiayin Yao1– 3,* 

1Department of Gastroenterology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, 515000, People’s Republic of China; 2Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 515000, People’s Republic of China; 3Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, 515000, People’s Republic of China; 4Department of Anesthesiology, The Affiliated TCM Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 515000, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Jiayin Yao, Department of Gastroenterology, the Sixth Affiliated Hospital, Sun Yat-sen University, 26 Erheng Road, Yuancun, Tianhe District, Guangzhou, Guangdong, 510655, People’s Republic of China, Tel/Fax +86-20-38254101, Email yjyin@mail2.sysu.edu.cn Min Zhi, Department of Gastroenterology, the Sixth Affiliated Hospital, Sun Yat-sen University, 26 Erheng Road, Yuancun, Tianhe District, Guangzhou, Guangdong, 510655, People’s Republic of China, Tel/Fax +86-20-38254101, Email zhimin@mail.sysu.edu.cn

Background and Aims: Inflammatory Bowel Disease presents significant management challenges, particularly in pediatric and elderly populations with refractory conditions. Despite advances in biologic therapies, current treatments remain limited with inconsistent response rates. This study investigated Upadacitinib efficacy in Asian adolescent and elderly populations with refractory IBD.
Methods: This single-center, retrospective cohort study examined 21 patients at the Sixth Affiliated Hospital of Sun Yat-sen University: 11 pediatric refractory CD patients (aged 9– 17) and 10 elderly refractory UC patients (aged 60+). Diagnoses were confirmed via comprehensive criteria including clinical symptoms, biomarkers, endoscopic findings, histological examination, and radiological results. Patients had refractory IBD, defined as failure of at least two biologic agents with distinct mechanisms or comorbid psychosocial complications impairing disease management.
Results: Pediatric CD patients showed remarkable efficacy, with 72.7% achieving steroid-free clinical remission at week 12, maintained at 57.1% by week 24, and reaching 88.9% at final follow-up. Endoscopic remission improved from 50% at week 12 to 57.1% at final follow-up. Elderly UC patients showed modest outcomes, with 20% achieving clinical remission throughout the study. Laboratory parameters demonstrated significant improvements, particularly in C-reactive protein and albumin levels. The safety profile was generally favorable with minimal adverse events. Teenage CD patients experienced minor dermatological side effects, while UC patients showed no significant adverse events. One serious pneumonia case in the elderly group highlighted potential infection risks.
Conclusion: This pioneering Asian study provides critical insights into UPA’s potential as alternative treatment for challenging IBD cases in adolescent and elderly populations, demonstrating different efficacy and safety profiles across age groups and contributing evidence for personalized medicine approaches in managing refractory IBD.

Keywords: upadacitinib, inflammatory bowel disease, (IBD), pediatric crohn’ s disease, geriatric ulcerative colitis, refractory IBD