A medicine already used to treat inflammatory bowel disease (IBD) may help people with a difficult form of Crohn’s disease affecting the area around the anus, according to research published by Devi and colleagues. The study looked at upadacitinib, a type of medicine called a JAK inhibitor, in patients with perianal Crohn’s disease.
What the study found
The research involved 125 people with perianal Crohn’s disease who were treated with upadacitinib. Perianal Crohn’s disease causes inflammation around the back passage and can lead to painful complications such as abscesses and fistulas, which are abnormal tunnels that form between the bowel and skin.
The study reported that just over 39 per cent of patients achieved clinical remission, meaning their symptoms improved significantly. A larger proportion, around 45 per cent, saw some improvement without reaching full remission.
The researchers also used pelvic MRI scans to check for healing beneath the surface, something earlier studies had not done. Of the 78 patients scanned, about two thirds showed improvement in their fistulas and roughly one in nine had healed completely, offering more objective evidence that the treatment was working.
Some patients responded better than others. Those not previously treated with an anti-TNF medicine (a common Crohn’s treatment) were about twice as likely to respond, as were those who had lived with symptoms for a shorter time. This hints that upadacitinib may work best when used earlier, though more research is needed to confirm this.
Why this matters
Perianal Crohn’s disease is one of the more challenging forms of the condition to treat. It can significantly affect quality of life and often requires specialist care. Many people with this complication need a combination of treatments, including medicines that calm the immune system and sometimes surgery.
Upadacitinib is already approved for treating Crohn’s disease in the UK and works by blocking certain signals in the immune system that drive inflammation. This study suggests it may also be helpful specifically for perianal symptoms, though more research is needed to confirm these findings and understand which patients are most likely to benefit.
What to keep in mind
The findings come from real-world data, meaning they reflect how the medicine performs in everyday clinical practice rather than in a controlled trial setting. This type of evidence is valuable but may not capture all the factors that influence treatment outcomes.
It is important to remember that not all patients responded to the treatment, and the study does not tell us how upadacitinib compares directly to other medicines used for perianal Crohn’s disease. The decision to use this or any other treatment should be made with a gastroenterologist who can consider individual circumstances, disease severity, and previous treatments.
Perianal Crohn’s disease often requires ongoing monitoring and a tailored treatment approach. While these results are encouraging, further studies are needed to clarify the role of upadacitinib in managing this complication and to identify which patients are most likely to benefit.
Reference
Devi J, Patel A, Quraishi B, Dev B, Tan T, Kline M, Chowla N, Ramesh PR, Ballard DH, Huang L, Jaiprada F, Samaan S, Stone M, Khan A, Seeraj AA, Alanazi S, Xu A, Maas L, Jajoo A, Parian A, Altinmakas E, Ehman EC, Davenport MS, Li S, Chithriki M, Shukla R, McCurdy J, Yarur AJ, Bishu S, Johnson AM, Benjamin M, Dulaney D, Serre-Yu W, Deepak P. Real-World Effectiveness of Upadacitinib for Perianal Crohn’s Disease: A Multicenter Retrospective Study. Clin Gastroenterol Hepatol. 2026 May 15:S1542-3565(26)00332-0. doi: 10.1016/j.cgh.2026.05.003. Epub ahead of print. PMID: 42142719.
This article is a journalistic summary for informational purposes only. It does not constitute clinical advice or a recommendation to alter treatment decisions.