Upadacitinib represents a potential therapeutic option for patients with anti-TNF-refractory intestinal Behçet's disease, with 50% achieving complete remission at month 6.
Key Findings
Results
At month 6, 50% of patients with anti-TNF-refractory intestinal Behçet's disease who underwent endoscopy achieved complete remission based on a composite disease activity index.
Complete remission (CR) was achieved in 8 of 16 patients (50.0%) who underwent endoscopic evaluation at month 6
CR was defined by a composite disease activity index incorporating global gastrointestinal (GI) symptom score and endoscopic evaluation
The study included 17 consecutive patients from a maintained BD registry at Peking Union Medical College Hospital between July 2024 and April 2026
All patients had previously failed anti-TNF therapy
Results
CR of global GI symptom score was observed in 76.5% of patients at month 6.
13 of 17 patients (76.5%) achieved CR of global GI symptom score
Mucosal healing was achieved in 50% (8/16) of patients who underwent endoscopic evaluation
These endpoints were assessed at the 6-month timepoint
Results
Median DAIBD score decreased markedly from baseline to month 6.
Median DAIBD score decreased from 55.0 (IQR 45.0–80.0) at baseline to 0.0 (IQR 0.0–10.0) at month 6
DAIBD stands for Disease Activity Index for Intestinal Behçet's Disease
Significant reductions in inflammatory markers CRP and ESR also accompanied the DAIBD improvement
Results
Upadacitinib demonstrated a glucocorticoid-sparing effect in anti-TNF-refractory intestinal Behçet's disease.
Reduction in glucocorticoid dosage was observed as a secondary endpoint
The glucocorticoid-sparing effect was noted alongside clinical and endoscopic improvements
This finding is clinically relevant given the long-term risks associated with chronic glucocorticoid use
Methods
Upadacitinib was initiated at 15 mg daily, with dose escalation to 30 mg in the majority of patients due to inadequate response.
All 17 patients started upadacitinib at 15 mg per day
9 of 17 patients (approximately 53%) required dose escalation to 30 mg daily due to inadequate response
This dose escalation pattern reflects real-world clinical management in a refractory population
Results
Upadacitinib was generally well tolerated in this patient population.
Safety was assessed as a secondary endpoint
The paper reports that upadacitinib was 'generally well tolerated'
The study was retrospective and included 17 patients, limiting the statistical power to detect rare adverse events
What This Means
This research suggests that upadacitinib, a JAK inhibitor medication, may be a useful treatment option for patients with intestinal Behçet's disease who have not responded adequately to anti-TNF therapies (a common class of biologic drugs). In this small retrospective study of 17 patients treated at a single hospital in China, half of the patients who had an endoscopy at six months showed complete remission by combined symptom and endoscopic measures, and more than three-quarters experienced resolution of their gastrointestinal symptoms. The disease activity score dropped dramatically from a median of 55 points at the start of treatment to 0 points at six months, and inflammatory markers in the blood also fell significantly.
The study also found that upadacitinib allowed patients to reduce their use of glucocorticoids (steroids), which is important because long-term steroid use carries significant health risks. Treatment was started at a lower dose (15 mg daily), but about half of the patients needed the dose increased to 30 mg daily because they did not respond fully to the lower dose. The drug was generally well tolerated across the study period.
This research matters because intestinal Behçet's disease is a rare and difficult-to-treat condition, and patients who fail anti-TNF therapies have very limited options. While this study is small and retrospective — meaning it looked back at existing patient records rather than running a controlled trial — it provides early evidence that upadacitinib could fill an important gap for this challenging patient population. Larger, prospective, controlled studies would be needed to confirm these findings and better characterize long-term safety.
Wu J, Wang J, Bai X, Liu Y, Ao Y, Liu J, et al.. (2026). Efficacy and safety of upadacitinib in anti-TNF-refractory intestinal Behçet's disease: a single-center retrospective study.. Rheumatology (Oxford, England). https://doi.org/10.1093/rheumatology/keag489