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Upadacitinib (UPA) was recently approved for use in Ulcerative colitis and Crohn’s disease in adults, Despite the promising data in the adult field, still limited data available for use in paediatrics. 1 Upadacitinib is a Janus kinase inhibitor licensed for adult IBD and possesses numerous benefits of being a small molecule, oral administration, and no immunogenicity.2 Upadacitinib targets JAK1, thus limiting immune cell adhesion and release of cytokines.3 We identified patients who were <= 18 with refractory IBD who were started on Upadacitinib (UPA). The data collected from the electronic records included the type of disease and its extent, age at diagnosis and age at starting UPA, duration of the disease, what biologics failed before, what the outcome of treatment based on symptoms, blood test (including inflammatory markers (CRP, Albumin, faecal calprotectin).We had six patients with refractory IBD who received UPA,50% were male. The age at the start of UPA ranged from 14.5 y-18 ys (mean age 13.3 years), with a disease duration ranging between 4.5 ys -10 ys (mean 6.3 years).All the patients had Crohn’s disease; four had the non-structuring disease (B1) (three of those had ileocolonic and one had colonic disease), and the remaining two had a perianal fistulating disease.All the patients were biologic-exposed, (60%(n=4) were exposed to three previous biologics), and the 40%(n=2) had two previous biologics. Before initiating UPA 83%(n=5) received infliximab, 50%(n=3) had adalimumab,50% Vedolimumab,66%(n=4) had Ustekinumab,66%(n=4) had Azathioprine. All patients received UPA as monotherapy.UPA induction was administered for 12 weeks at a dose of 45 mg once a day, then reduced to 15 mg as maintenance. Only one patient was kept on 30 mg due to chronic renal disease. Duration on UPA use ranged from 6 months to 16 m (Median 8 m). Three patients were transitioned to adult services. One patient was excluded due to non-compliance (poor engagement with the medical professionals, social/behavioural issues).Of the 5 compliant patients, 80%(n=4) responded well with improved symptoms and blood results. Only one (20%) did not respond, He was transitioned to the adult services on UPA and after 6 months of treatment needed to switch to Risankizumab due to primary non-respondent (this patient had perianal Crohn’s disease and severe anxiety).UPA shows promising results but further national and international studies are needed to prove the results found in our centre.Abstract OC34 Table 1Demographic details of the patient’s cohort treated with upadacitinib Case Gender Type of IBD Age at diagnosis Age at starting UPA Disease Duration Duration of therapy Previous Biologics Outcome 1 Female Crohn’s non-structuring B1, ileocolic L3 6.5 ys 16.6 ys 10.5 ys 16 ms 3 Responded 2 male Crohn’s perianal fistulating 10.5 ys 14.8 ys 4.5 ys Non-compliant 2 Non-compliant 3 male Crohn’s perianal Fistulating +L2 colonic 10 ys 18 ys 8 ys 6 ms 3 Primary non-respondent/Transitioned 4 male Crohn’s non-structuring B1, ileocolic L3 9 ys 15.5 ys 7 ys 8 ms 2 Responded/Transitioned 5 Female Crohn’s non-structuring B1, colonic L2 13 ys 17 ys 4 ys 8 ms 2 Responded/Transitioned 6 Female Crohn’s non-structuring B1, ileocolic L3 10 ys 14.5 ys 4 ys 7 ms 3 Responded References Bergstein S, Spencer E. Single centre experience with upadacitinib for refractory pediatric inflammatory bowel disease. Gastroenterology 2023 Apr;164(4):S79.Elford AT, Bishara M, Plevris N, Gros B, Constantine-Cooke N, Goodhand J, et al. Real-world effectiveness of upadacitinib in crohn’s disease: a UK multicentre retrospective cohort study. Frontline Gastroenterol. 2024 Jul;15(4):297–304.Miller M, Patel AS, Pasternak B. Rescue therapy with upadacitinib in medically refractory paediatric ulcerative colitis. JPGN Rep. 2024 May;5(2):197–9.