Filgotinib vs upadacitinib in ulcerative colitis – which is better?

Review by Prof. Edyta Tulewicz-Marti (Poland)

Study Summary 

This was a multicenter real-world retrospective cohort study of the effectiveness and safety of upadacitinib (UPA) and filgotinib (FIL) in ulcerative colitis. 168 patients were enrolled in the study; 98 patients received FIL and 70 UPA. Clinical remission at 8 weeks was achieved in 46.9% patients treated with FIL compared to 65.7% with UPA; however, adverse events were more frequent with UPA than with FIL.

Commentary 

Given the variety of biologics now available for the treatment of inflammatory bowel disease (IBD), a personalized approach to the treatment of patients with IBD has become possible but also presents the challenge of selecting the right agent for a given patient. Data from the above presented study may be helpful in making a choice between two JAK inhibitors but illustrates the challenges we face. While, on the one hand, UPA was more effective than FIL, on the other, AEs were more frequent with UPA, in this group of patients. Interestingly, when prior exposure to tofacitinib was taken into account, results were similar in both groups. The study has significant limitations: retrospective, non-randomized and, critically, the patients were not subjected to endoscopic evaluation so endoscopic and histologic remission rates cannot be compared. To permit a true comparison between these agents a prospective randomized study will be required.

Citation

Nogami A, Asonuma K, Okabayashi S, et al. Real-World Comparative Effectiveness and Safety of Filgotinib and Upadacitinib for Ulcerative Colitis: A Multicentre Cohort Study. United European Gastroenterol J. 2024;12:1357-1366

View past News You Can Use commentaries