New real-world data from nearly 15,000 ulcerative colitis patients suggest higher doses of JAK and IL-23 inhibitors lead to better remission rates — but clinicians say it's not a simple "more is better" story. Safety risks, patient preferences, and disease severity all factor into the equation. Experts stress the need for individualized, biomarker-informed dosing strategies.
A large real-world study of nearly 15,000 ulcerative colitis (UC) patients found that higher doses of JAK inhibitors and IL-23 inhibitors were associated with significantly better remission rates at 6 months, fewer hospitalizations, and lower rates of colon surgery by 12 months. But gastroenterologists are quick to caution: this isn't a blanket prescription for maximum dosing.
Experts emphasize that the right dose depends on a patient's disease severity, safety profile, and personal preferences. JAK inhibitors carry FDA boxed warnings for serious cardiovascular events, cancer, venous thromboembolism, and death — making higher doses a more complex call. IL-23 inhibitors have a more favorable safety profile, though higher doses are linked to increased shingles risk.
By the Numbers
Why it matters: With several of these drugs only recently FDA-approved for UC, clinicians are still building experience. The lack of a precise biomarker-driven dosing algorithm means treatment decisions remain highly individualized — and getting the dose right could mean the difference between remission and ongoing inflammation, steroid dependence, or surgery.
