The role of upadacitinib in the treatment of ulcerative colitis

The JAK signaling pathway plays a major role in the immunopathology of autoimmune diseases, including inflammatory bowel disease. JAK enzymes provide novel targets for rapidly effective inflammatory bowel disease therapy, particularly in ulcerative colitis. Upadacitinib is a targeted JAK1 inhibitor. In multiple phase III clinical trials, upadacitinib has demonstrated significant improvement in clinical and endoscopic outcomes and quality of life for patients with moderate-to-severe ulcerative colitis. In this drug evaluation we describe the role of the JAK signaling pathway in ulcerative colitis, the mechanism of action of upadacitinib and the current clinical evidence for its use in ulcerative colitis; we also review its safety and tolerability, including for special populations. Tweetable abstractIn this drug evaluation we describe the mechanism of action of novel JAK1 inhibitor upadacitinib, the role of the JAK signaling pathway in ulcerative colitis and the clinical evidence for upadacitinib in ulcerative colitis. Plain language summaryThe drug upadacitinib has recently been approved for use in the USA and the UK for patients with moderate-to-severe ulcerative colitis. This article discusses a protein called JAK, which increases inflammation in the body. Inflammation causes symptoms such as soreness, swelling and redness. Upadacitinib blocks JAK from working, which means there is less inflammation and a reduction in these symptoms. This article also discusses the clinical trials that have looked at the safety and efficacy (how well a treatment works) of upadacitinib for ulcerative colitis. Overall, the treatment has been shown to be fast-acting, safe and effective in patients with moderate-to-severe ulcerative colitis. People with ulcerative colitis should ask their healthcare provider if upadacitinib is a suitable treatment option for their disease.