Use of upadacitinib in a child with refractory ulcerative colitis

Abstract

Upadacitinib a selective Janus kinase inhibitor that belongs to the group of targeted immunosuppressors or selective immu-nosuppressants, has emerged as a new strategy for immune-mediated diseases. Previously, clinical cases and studies on adult patients with inflammatory bowel disease were mostly found in the literature; in paediatric practice, this experience is very limited. Use in children is still off-label due to the lack of randomized trials. In the presented clinical case, this drug was prescribed to a 15-year-old boy for a refractory course of ulcerative colitis that had previously lost response to anti-TNF, therapy with vedolizumab and tofacitinib was also failed. Given the unsuccessful previous treatment experience, a child with refractory ulcerative colitis was prescribed upadacitinib. The drug was prescribed at a dose of 45 mg once a day for 8 weeks, then it was suggested to switch to a maintenance dose of 15 mg once a day. Without systemic glucocorticosteroid use, the patient's complaints, clinical, laboratory, and endoscopic changes persisted, but on upadacitinib therapy the boy was able to discontinue glucocorticosteroid. This example illustrates the positive dynamics according to clinical, laboratory and endoscopic data on the background of selective inhibitor of Janus kinases. A growing number of clinical cases using Janus kinase inhibitors show the need for clinical trials in a pediatric group of patients with refractory inflammatory bowel disease.