Am J Gastroenterol

Infliximab and upadacitinib lead to rapid symptom improvement in severe ulcerative colitis

February 10, 2026

A post‑hoc analysis of 11 randomized trials evaluated how quickly advanced therapies induce symptom improvement in 1,781 biologic‑naïve patients with ulcerative colitis (UC) and severe endoscopic disease. At week 2, infliximab (35.1%) and upadacitinib (32.4%) achieved the highest early PRO‑2 response rates (defined as ≥50% reduction in stool frequency and rectal bleeding). Compared with placebo, odds of early response were greatest with upadacitinib (adjusted odds ratio [aOR], 6.38; 95% confidence interval [CI], 2.11–19.23) and infliximab (aOR, 4.49; 95% CI, 2.05–9.85). These agents also led post‑induction PRO‑2 responses, while severe endoscopic disease was associated with reduced response to several other therapies.

Clinical takeaway: In biologic‑naïve UC with severe endoscopic activity, infliximab or upadacitinib may be preferred when rapid symptom control is a priority.

Source:

Wong ECL, et al. (2026, February 2). Am J Gastroenterol. Infliximab and Upadacitinib Demonstrate Superior Early Onset of Efficacy in Biologic-Naïve Ulcerative Colitis with Severe Endoscopic Disease. https://pubmed.ncbi.nlm.nih.gov/41626838/