{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T21:52:27Z","timestamp":1790113947056,"version":"4.0.1"},"reference-count":16,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,21]],"date-time":"2025-09-21T00:00:00Z","timestamp":1758412800000},"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>This case report describes four pediatric patients with severe, therapy-refractory ulcerative colitis (UC) and one pediatric patient with severe, therapy-refractory Crohn\u2019s disease (CD), all of whom failed widely used biologic therapies, including the approved treatments infliximab and adalimumab, as well as off-label use of vedolizumab and ustekinumab. Despite these first- and second-line interventions, patients\u2019 diseases remained active. Following the initiation of upadacitinib, an off-label Janus kinase (JAK) inhibitor with positive results in adult UC and CD patients, four children experienced rapid symptom improvement and achieved clinical remission. The rising incidence of pediatric inflammatory bowel disease (IBD) and the limited number of approved therapies underscore the need for additional treatment options in pediatric gastroenterology. Infliximab remains one of the only biologic therapies approved for pediatric UC and CD, forcing clinicians to rely on off-label medications, such as vedolizumab, ustekinumab, and upadacitinib, when standard treatments fail. To address this gap, it is crucial to include pediatric patients in clinical trials of new therapies, expanding the range of approved medications and improving outcomes for children with IBD.<\/jats:p>","DOI":"10.3390\/children12091268","type":"journal-article","created":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T08:37:39Z","timestamp":1758530259000},"page":"1268","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Efficacy of Modified Upadacitinib Dosing in Pediatric Refractory IBD: A Case-Based Analysis"],"prefix":"10.3390","volume":"12","author":[{"given":"Frank Risto","family":"Rommel","sequence":"first","affiliation":[{"name":"Department of General Pediatrics, University Children\u2019s Hospital Marburg, University of Marburg, 35408 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christa","family":"Bergheim","sequence":"additional","affiliation":[{"name":"Department of Neonatology and Pediatric Gastroenterology, Children\u2019s Hospital Kassel, Klinikum Kassel, 34125 Kassel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2822-1991","authenticated-orcid":false,"given":"Inga","family":"Jerrentrup","sequence":"additional","affiliation":[{"name":"Department of General Pediatrics, University Children\u2019s Hospital Marburg, University of Marburg, 35408 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9498-2337","authenticated-orcid":false,"given":"Stefanie","family":"Weber","sequence":"additional","affiliation":[{"name":"Department of General Pediatrics, University Children\u2019s Hospital Marburg, University of Marburg, 35408 Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4008-7185","authenticated-orcid":false,"given":"Andreas","family":"Jenke","sequence":"additional","affiliation":[{"name":"Department of General Pediatrics, University Children\u2019s Hospital Marburg, University of Marburg, 35408 Marburg, Germany"},{"name":"Department of Neonatology and Pediatric Gastroenterology, Children\u2019s Hospital Kassel, Klinikum Kassel, 34125 Kassel, Germany"},{"name":"Department of Medicine, Faculty of Health, University of Witten\/Herdecke, 58455 Witten, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e2022058037","DOI":"10.1542\/peds.2022-058037","article-title":"Pediatric Inflammatory Bowel Disease","volume":"151","author":"Bouhuys","year":"2023","journal-title":"Pediatrics"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1007\/s00384-024-04640-9","article-title":"Changing epidemiology of inflammatory bowel disease in children and adolescents","volume":"39","author":"Long","year":"2024","journal-title":"Int. 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