ReviewCureus2026
Impact of Prior Biologic Exposure on Upadacitinib Efficacy in Inflammatory Bowel Disease: A Systematic Review of Randomized Controlled Trials.
Review in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Whether prior biologic exposure attenuates the efficacy of upadacitinib (UPA), a selective JAK-1 inhibitor, in inflammatory bowel disease (IBD) remains unresolved. This systematic review addresses this question across the induction and maintenance phases of ulcerative colitis (UC) and Crohn's disease (CD). PubMed/MEDLINE, ScienceDirect, Scopus, and ClinicalTrials.gov were searched through from inception to January 2026 per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 (PROSPERO: CRD420261287632). Eligible studies were Phase 3 randomised controlled trials (RCTs) in moderate-to-severe UC or CD reporting subgroup data by biologic exposure status. Risk of bias was assessed with Cochrane RoB 2; narrative synthesis followed the Synthesis Without Meta-analysis (SWiM) framework. Three studies with six Phase 3 programs were included, all at low overall risk of bias. While therapeutic response rates were numerically lower in patients with prior biologic exposure, UPA demonstrated sustained therapeutic benefit observed across all subgroups. In Crohn's disease, stratified risk differences (RD) for clinical remission consistently favored UPA over placebo (RD range: 14.5-33.0 pp). While biologic-naive patients achieved numerically higher remission rates, biologic-experienced patients retained meaningful clinical and endoscopic benefit at one year. In ulcerative colitis, UPA demonstrated superior efficacy across all primary endpoints compared to placebo. Safety data revealed a dose-dependent increase in adverse events (e.g., herpes zoster, hepatic enzyme elevations) at 30 mg compared to 15 mg in the maintenance phase. UPA provides clinically meaningful remission in biologic-experienced IBD patients across both UC and CD. Although prior biologic exposure is associated with lower absolute remission rates, the sustained therapeutic benefit supports UPA as a viable salvage option. Further research with head-to-head trials is needed.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.