Upadacitinib in Biologic-Naïve Patients With Acute Severe Ulcerative Colitis: A Case Report of a Promising Alternative Rescue Therapy

Acute severe ulcerative colitis (ASUC) is a known complication of ulcerative colitis (UC). Treatment of ASUC is with intravenous (IV) corticosteroids as first-line therapy and with infliximab or cyclosporine as rescue therapy in disease refractory to steroids. Upadacitinib is a newer and alternative therapy for patients, particularly after they have received at least one approved systemic therapy, if tumor necrosis factor (TNF) blockers are clinically inadvisable. We present a case of a biologic-naïve hospitalized patient with corticosteroid-refractory ASUC, who was not initially treated with TNF inhibitor therapy, yet who achieved excellent outcomes with upadacitinib salvage therapy. Upadacitinib can have potential benefits as an alternative rescue therapy in the management of select ASUC cases. Though rescue therapy options exist, patients often still require surgical management, requiring further alternative treatments for ASUC. Upadacitinib can serve as a promising treatment for ASUC, with new expanded indications further justifying its utility.