Upadacitinib and Risankizumab Show Comparable Remission in Crohn’s Disease After Anti-TNF Failure
A retrospective study found comparable corticosteroid-free remission with upadacitinib and risankizumab in anti-TNF-exposed Crohn’s patients. Upadacitinib showed higher endoscopic remission at week 52 but more adverse events. Both JAK and IL-23 inhibitors are shaping the growing IBD treatment market.
A retrospective cohort study of anti-TNF-exposed adults with Crohn’s disease found comparable corticosteroid-free clinical remission rates at 12 to 24 weeks after induction with upadacitinib versus risankizumab, with no significant difference after adjustment for disease severity (adjusted odds ratio 1.05; 95% CI 0.46-2.41; P=0.906). The analysis, published in Clinical Gastroenterology and Hepatology, included 175 patients (risankizumab n=115; upadacitinib n=60) who started treatment between January 2022 and November 2025. At baseline, a higher proportion of the upadacitinib group had severe disease (27% vs 10%).
Unadjusted postinduction corticosteroid-free clinical remission was 60% (33/55) for upadacitinib and 55% (60/109) for risankizumab. The combined endpoint of corticosteroid-free clinical and biochemical remission also showed no significant between-group difference (adjusted odds ratio 1.14; 95% CI 0.48-2.72; P=0.763). Both treatments led to significant median reductions in C-reactive protein, fecal calprotectin, and Simple Endoscopic Score for Crohn’s Disease from baseline to postinduction. At week 52, upadacitinib was associated with higher odds of endoscopic remission (adjusted OR 7.96; 95% CI 1.7-37.23; P=0.009), though endoscopic follow-up was limited. Treatment persistence did not differ significantly (hazard ratio 1.08; 95% CI 0.51-2.27; P=0.845).
Adverse events were more common in the upadacitinib group (43.3% vs 22.6%; adjusted OR 3.26; 95% CI 1.46-7.32; P=0.004). Serious adverse events occurred in 23.3% of upadacitinib patients and 15.7% of risankizumab patients. Infectious complications were numerically higher with upadacitinib (13.3% vs 4.3%) but did not reach significance after adjustment (aOR 3.4; 95% CI 0.9-12.89; P=0.072).
Upadacitinib, a JAK inhibitor developed by AbbVie, is recognized for its rapid onset and convenient oral delivery, offering quick symptom improvement, though cardiovascular and infectious risks require monitoring. Risankizumab, an IL-23 inhibitor also from AbbVie, selectively targets inflammatory pathways and has demonstrated a favorable safety and efficacy balance, positioning it as a cornerstone therapy in moderate-to-severe disease. The global IBD therapeutics market is projected to surpass $30 billion by the end of the decade, fueled by such targeted treatments.