{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T21:52:19Z","timestamp":1790113939596,"version":"4.0.1"},"reference-count":16,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,3,22]],"date-time":"2025-03-22T00:00:00Z","timestamp":1742601600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: In adolescent patients with ulcerative colitis refractory to anti-tumor necrosis factor (TNF) therapy, episodes of acute severe ulcerative colitis (ASUC) require hospitalization or surgery. Upadacitinib can be a potential colectomy-sparing agent in adult ASUC patients receiving intensified dosing. Methods: This case series evaluates clinical outcomes of intensified rescue upadacitinib dosing in adolescent patients with ASUC. We included adolescents admitted with anti-TNF refractory ASUC treated with 30 mg twice daily upadacitinib. The primary outcome was the proportion of patients who remained colectomy-free at the most recent follow-up. Results: Five patients (aged 14\u201318) exhibited varying responses to upadacitinib; 2 responded rapidly, while 3 had partial response. All the patients remained on upadacitinib and were colectomy-free during follow-up (55\u2013203 days). Three (60%) ultimately received dual advanced therapy with ustekinumab and upadacitinib. At most recent follow-up, 60% were in clinical\/biochemical remission without corticosteroids. Conclusions: In select cases, intensified upadacitinib may be a potential colectomy-sparing option for adolescent ASUC patients refractory to anti-TNF therapy.<\/jats:p>","DOI":"10.3390\/children12040401","type":"journal-article","created":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T13:48:20Z","timestamp":1742824100000},"page":"401","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Intensified Upadacitinib Dosing for Adolescent Patients with Acute Severe Ulcerative Colitis"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8287-3424","authenticated-orcid":false,"given":"Perseus V.","family":"Patel","sequence":"first","affiliation":[{"name":"Division of Pediatric Gastroenterology, Department of Pediatrics, Stanford Medicine Children\u2019s Health, Center for IBD and Celiac Disease, Stanford University School of Medicine, Palo Alto, CA 94304, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Rigmaiden","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Department of Pediatrics, Stanford Medicine Children\u2019s Health, Center for IBD and Celiac Disease, Stanford University School of Medicine, Palo Alto, CA 94304, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alka","family":"Goyal","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Department of Pediatrics, Stanford Medicine Children\u2019s Health, Center for IBD and Celiac Disease, Stanford University School of Medicine, Palo Alto, CA 94304, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Bensen","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Department of Pediatrics, Stanford Medicine Children\u2019s Health, Center for IBD and Celiac Disease, Stanford University School of Medicine, Palo Alto, CA 94304, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorsey","family":"Bass","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Department of Pediatrics, Stanford Medicine Children\u2019s Health, Center for IBD and Celiac Disease, Stanford University School of Medicine, Palo Alto, CA 94304, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6660-4494","authenticated-orcid":false,"given":"Jonathan","family":"Moses","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Department of Pediatrics, Stanford Medicine Children\u2019s Health, Center for IBD and Celiac Disease, Stanford University School of Medicine, Palo Alto, CA 94304, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5149-718X","authenticated-orcid":false,"given":"Michael J.","family":"Rosen","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Department of Pediatrics, Stanford Medicine Children\u2019s Health, Center for IBD and Celiac Disease, Stanford University School of Medicine, Palo Alto, CA 94304, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9891-8570","authenticated-orcid":false,"given":"Ruben J.","family":"Colman","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Department of Pediatrics, Stanford Medicine Children\u2019s Health, Center for IBD and Celiac Disease, Stanford University School of Medicine, Palo Alto, CA 94304, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,22]]},"reference":[{"key":"ref_1","first-page":"56","article-title":"Contemporary Medical Management of Acute Severe Ulcerative Colitis","volume":"25","author":"Whaley","year":"2019","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1913","DOI":"10.1016\/j.cgh.2023.03.001","article-title":"Upadacitinib Is Effective and Safe in Both Ulcerative Colitis and Crohn\u2019s Disease: Prospective Real-World Experience","volume":"21","author":"Friedberg","year":"2023","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2347","DOI":"10.1016\/j.cgh.2022.11.029","article-title":"Upadacitinib Therapy Reduces Ulcerative Colitis Symptoms as Early as Day 1 of Induction Treatment","volume":"21","author":"Loftus","year":"2023","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.14309\/ajg.0000000000002674","article-title":"Effectiveness of Upadacitinib for Patients with Acute Severe Ulcerative Colitis: A Multicenter Experience","volume":"119","author":"Berinstein","year":"2024","journal-title":"Am. J. Gastroenterol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2057","DOI":"10.1093\/ibd\/izad300","article-title":"Single-Center Experience with Upadacitinib for Adolescents with Refractory Inflammatory Bowel Disease","volume":"30","author":"Spencer","year":"2023","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1002\/jpr3.12067","article-title":"Rescue Therapy with Upadacitinib in Medically Refractory Pediatric Ulcerative Colitis","volume":"5","author":"Miller","year":"2024","journal-title":"JPGN Rep."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1056\/NEJMoa1606910","article-title":"Tofacitinib as Induction and Maintenance Therapy for Ulcerative Colitis","volume":"376","author":"Sandborn","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_8","unstructured":"Higgins, P.D.R., Rogenbogen, S., Patel, S., Waljee, A., Hardiman, K., Manoogian, B., Kinnucan, J., Govani, S., Morris, A., and Cushing, K. (2023, July 01). University of Michigan Severe Ulcerative Colitis Protocol. Available online: https:\/\/www.med.umich.edu\/ibd\/docs\/severeucprotocol.pdf."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Levitte, S., Yarani, R., Ganguly, A., Martin, L., Gubatan, J., Nadel, H.R., Franc, B., Gugig, R., Syed, A., and Goyal, A. (2023). Case Series of Precision Delivery of Methylprednisolone in Pediatric Inflammatory Bowel Disease: Feasibility, Clinical Outcomes, and Identification of a Vasculitic Transcriptional Program. J. Clin. Med., 12.","DOI":"10.3390\/jcm12062386"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1097\/MPG.0000000000002036","article-title":"Management of Paediatric Ulcerative Colitis, Part 2: Acute Severe Colitis\u2014An Evidence-Based Consensus Guideline from the European Crohn\u2019s and Colitis Organization and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition","volume":"67","author":"Turner","year":"2018","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1111\/apt.13491","article-title":"Review Article: The Practical Management of Acute Severe Ulcerative Colitis","volume":"43","author":"Seah","year":"2016","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.1093\/ecco-jcc\/jjac073","article-title":"Thromboprophylaxis Use in Paediatric Inflammatory Bowel Disease: An International RAND Appropriateness Panel","volume":"16","author":"Torrente","year":"2022","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2858","DOI":"10.1016\/j.cgh.2022.02.050","article-title":"Early Symptomatic Improvement After Ustekinumab Therapy in Patients with Ulcerative Colitis: 16-Week Data from the UNIFI Trial","volume":"20","author":"Danese","year":"2022","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1179\/106698110X12640740712699","article-title":"Clinimetrics Corner: The Many Faces of Selection Bias","volume":"18","author":"Hegedus","year":"2010","journal-title":"J. Man. Manip. Ther."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1016\/j.cgh.2022.08.016","article-title":"Multicenter Cohort Study of Infliximab Pharmacokinetics and Therapy Response in Pediatric Acute Severe Ulcerative Colitis","volume":"21","author":"Whaley","year":"2023","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2112","DOI":"10.1016\/j.cgh.2021.05.038","article-title":"Tofacitinib for Biologic-Experienced Hospitalized Patients with Acute Severe Ulcerative Colitis: A Retrospective Case-Control Study","volume":"19","author":"Berinstein","year":"2021","journal-title":"Clin. Gastroenterol. Hepatol."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/4\/401\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:58:18Z","timestamp":1760029098000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/4\/401"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,22]]},"references-count":16,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["children12040401"],"URL":"https:\/\/doi.org\/10.3390\/children12040401","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,22]]}}}