Taha Qazi, MD: Finding Upadacitinib's Role in Crohn's Disease

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Qazi reviews the selective JAK1 inhibitor's benefit for patients who previously failed TNF inhibitor regimen.

The latest issue of Qazi Corner a collaborative quarterly newsletter on gastroenterology research, news, and trends between HCPLive and editor-in-chief Taha Qazi, MD—featured a review of upadacitinib, a selective JAK1 inhibitor for the treatment of Crohn’s disease.

Penned by Qazi’s colleague Ravi Shah, MD, the piece concluded with a note that upadacitinib is an “essential tool to add to current pharmacologic therapies against Crohn’s disease and especially in those who have previously failed conventional or biologic therapies.”

“Although there are potential adverse events to the medication, preventative care (i.e, vaccination) and careful monitoring (i.e, laboratory monitoring) may be efficient methods to curb these,” Shah wrote.

In a follow-up interview with HCPLive, Qazi, a gastroenterologist with the Cleveland Clinic, discussed what he called the “rapidly evolving” field of Crohn’s disease care and the role of upadicitinib in it.

“We’re obviously changing the way we manage the disease and complications from the disease,” Qazi said. “It represents a paradigm shift to a certain degree; all our prior treatments were infusions or injectables. It represents an area that patients want, which is a management strategy with oral therapy that’s effective for the management of a disease—especially a disease that’s severe and hard to treat.”

Qazi started using upadacitinib in practice early into its availability and shared details on the very positive interactions his patients have had receiving it. “I think when you have a patient who has very severe disease and has failed prior therapies…it’s a great option for the management of this disease,” he said.

Of course, due to its similarity to fellow selective JAK inhibitor tofacitinib, Qazi stressed caution in prescribing to patients who did not previously fail TNF inhibitor treatment.

Regarding his colleagues’ call for increased long-term data for upadacitinib in patients with Crohn’s disease, Qazi expressed interest in learning more what patient populations may be most suitable for treatment based on colonic versus small bowel-based disease.

“It would also be interesting to see how the agent works after multiple failures of medication, versus just 1-2 failures,” Qazi said. “We have some indirect comparisons that we can use sometimes in our meta-analyses, but overall I think there’s certain phenotypes where we should be using this medication more often.”

Read Shah's review of upadacitinib for the treatment of Crohn's disease here.

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