In UC patients who have failed two biologics, is adding upadacitinib or switching to risankizumab preferred for clinical remission

What is known

- In a network meta-analysis of induction trials, risankizumab 600mg ranked first for clinical remission in biologic-exposed patients (RR 0.74; 95% CI 0.67-0.82). ¹ - Upadacitinib 30mg once daily ranked first for maintenance of remission based on relapse of disease activity. ¹ - Real-world case series report upadacitinib remains effective in UC including after prior tofacitinib exposure/failure. ^1,2

What is unknown / caveats

- Induction rankings favour risankizumab while maintenance rankings favour upadacitinib — different endpoints, no single winner - Rankings come from indirect network comparison, not a head-to-head trial - The two-biologic-failed subgroup specifically is not isolated in the retrieved data - Corpus is Crohn's-surgery focused; broader UC medical-therapy literature may be missed - No direct upadacitinib-vs-risankizumab comparison in double-biologic-failed UC is available in the retrieved evidence.

## References

1. Gisbert JP, Chaparro M. Janus Kinase Inhibitors for Inflammatory Bowel Disease: Concise Questions and Answers on Their Use in Clinical Practice. Inflamm Bowel Dis. 2026;ePub only(4):ePub only. PMID: 41428330.

2. Friedberg S, Choi D, Hunold T, Choi NK, Garcia NM, Picker EA, Cohen NA, Cohen RD, Dalal SR, Pekow J, Sakuraba A, Krugliak Cleveland N, Rubin DT. Upadacitinib Is Effective and Safe in Both Ulcerative Colitis and Crohn's Disease: Prospective Real-World Experience. Clin Gastroenterol Hepatol. 2023;21(7):1913-1923.e2. PMID: 36898598.

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_Draft — generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct._