TOPLINE:

Among patients with active perianal Crohn's disease, nearly one quarter achieved clinical remission with upadacitinib, and nearly one third experienced a clinical response at 52 weeks.

METHODOLOGY:

• Researchers conducted a retrospective study across 13 French centres to examine whether upadacitinib provides sustained clinical benefit and acceptable safety at 1 year in perianal Crohn's disease and which patients respond best.
• They assessed 59 patients with active perianal Crohn's disease (median age, 38 years; 49% men) who had exposure to at least one advanced therapy before the initiation of upadacitinib, of whom 43 had fistulising perianal Crohn's disease and 16 had isolated anal ulceration.
• Participants received oral upadacitinib at an induction dose of 45 mg once daily for 12 weeks, followed by a maintenance regimen of either 15 or 30 mg once daily selected at physician discretion, with the option for a reinduction course of 45 mg daily for a minimum of 3 months on the basis of clinical judgement.
• The primary outcome was clinical remission at 52 weeks, defined as no draining pus — even with gentle pressure — and healed anal ulcerations and/or fissures, without adding any new dedicated treatment for perianal lesions.
• Secondary outcomes included clinical remission at weeks 12 and 24; clinical response (defined as at least a 50% improvement in fistulas and/or ulcerations) at weeks 12, 24, and 52; MRI-based remission and response; and safety including adverse events and serious adverse events (defined as those resulting in treatment interruption, hospitalisation, disability, persistent damage, digestive surgery, or death).

TAKEAWAY:

• At week 52, 71% of patients maintained upadacitinib treatment. Overall, 25% of patients achieved clinical remission — 25% in the isolated anal ulceration group and 26% in the fistulising group.
• In the fistulising group, 12% of patients achieved clinical remission and 63% showed clinical response at week 12; by week 24, remission was achieved in 26% of patients, and response was observed in 49% of patients. Outcomes were comparable in the isolated anal ulceration group.
• Radiologic (MRI) assessment of 13 patients in the fistulising group after a median of 29 weeks showed response in 69% and remission in 8% of patients.
• Adverse events occurred in 15 patients, and three serious adverse events of Crohn's exacerbations were reported. In univariable analysis, no clinical parameter was associated with clinical remission of fistulising perianal Crohn's disease at week 52.

IN PRACTICE:

"The observed 1-year clinical remission rate of 26% in fistulizing pCD [perianal Crohn's disease] supports the potential of upadacitinib as a treatment option in anti-TNF refractory pCD patients," the authors of the study wrote.

SOURCE:

This study was led by Nicolas Richard, University Rouen Normandie, INSERM, Rouen, France. It was published online on April 27, 2026, in Alimentary Pharmacology and Therapeutics.

LIMITATIONS:

The study was limited by its retrospective design and modest sample size. Clinical endpoints relied on the physician assessment of drainage and ulcer healing, and MRI was not centrally read, which may have introduced subjectivity and intercentre variability. Safety assessment was constrained by the cohort size and the absence of follow‑up beyond 1 year, which may have limited the detection of less frequent or late adverse events.

DISCLOSURES:

This study did not receive any funding. Several authors reported receiving research grants, consulting or advisory fees, lecture/honoraria payments, and travel or meeting support from multiple pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.