Targeting Objective Treatment Goals in Crohn's Disease - Episode 11

Use of Upadacitinib in Treatment of CD

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Remo Panaccione, MD, FRCPC, provides an overview of the newest oral therapy approved for CD, upadacitinib.

This is a video synopsis/summary of a panel discussion involving Marla Dubinsky, MD; David Rubin, MD; Miguel Regueiro, MD; Remo Panaccione, MD, FRCPC; and Sara Horst, MD, MPH.

The discussion shifts to the newest drug for Crohn's disease, upadacitinib, a selective JAK (Janus kinase) 1 inhibitor. The speaker outlines the mechanism of upadacitinib, distinguishing it from other JAK inhibitors and emphasizing its selectivity for JAK1. The drug's impact on the JAK-STAT pathway and its role in modulating gene transcription for pro-inflammatory cytokines are discussed.

Upadacitinib is highlighted for its specificity in targeting JAK1 without significant effects on JAK2, which reduces the risk of off-target effects associated with myelofibrosis and erythropoiesis. The speaker explains that JAK inhibitors act as competitive agonists, binding to the intracellular side of the receptor and competing for STAT activation.

The drug's approval for Crohn's disease is discussed, with a comparison to another treatment mentioned earlier in the conversation. The speaker notes that the data for upadacitinib, an oral small molecule, aligns closely with the effects of the mentioned treatment, administered differently. The discussion emphasizes the drug's effectiveness in achieving clinical and endoscopic remission, with particular attention to its rapid action, possibly quicker than other options.

The speaker shares personal experiences, mentioning that upadacitinib is used as a first-line therapy for Crohn's disease in Canada for about 15% of patients. The drug is frequently used clinical practice, attributed to its quick efficacy and ability to rescue a significant number of patients. The convenience of an oral small molecule is underlined, especially in gastrointestinal diseases, addressing pharmacodynamic challenges associated with monoclonal antibodies in inflamed guts.

In summary, upadacitinib emerges as a remarkable and versatile drug, praised for its selectivity, efficacy, and oral administration. The speaker's experiences and the drug's potential as a first-line therapy contribute to its significance in the evolving landscape of Crohn's disease treatment.

Video synopsis is AI-generated and reviewed by HCPLive editorial staff.