Upadacitinib vs Tofacitinib: CGH | 2026

Introduction:

Janus kinase (JAK) inhibitors have transformed the treatment of moderate-to-severe ulcerative colitis (UC), particularly in patients who have failed biologic therapies. However, direct comparisons between upadacitinib (UPA) and tofacitinib (TOFA) have been lacking. This multicenter real-world study compared their effectiveness and safety in bio-experienced patients.

Why was this study needed?

• No head-to-head randomized trial has compared upadacitinib and tofacitinib.
• Both JAK inhibitors are widely used in refractory UC.
• Clinicians need evidence to guide treatment selection.
• Comparative data on clinical and biochemical remission are limited.
• Real-world effectiveness may differ from clinical trial results.

Results:

• Upadacitinib achieved significantly higher rates of corticosteroid-free remission, clinical remission, and biochemical remission than tofacitinib during the first six months of treatment.
• Hospitalization and early colectomy rates were similar between the two treatment groups.
• No new safety concerns were identified with upadacitinib, supporting its favorable short- and mid-term safety profile.

Clinical Impact:

This large real-world study suggests that upadacitinib may be the preferred JAK inhibitor for bio-experienced patients with moderate-to-severe ulcerative colitis, offering superior effectiveness without compromising safety. However, prospective randomized trials are still needed to confirm these findings and evaluate long-term outcomes.

Bottom Line:

Upadacitinib outperformed tofacitinib in achieving corticosteroid-free, clinical, and biochemical remission in refractory ulcerative colitis. These findings support upadacitinib as the preferred JAK inhibitor for many patients requiring advanced oral therapy.