New DDW data on RINVOQ just changed what I'd ask a GI

By Kate — naturopath and Crohn's carer at The Crohn's Method. Written from professional training and lived family experience, to support (not replace) your medical care. Published 2026-07-09.

# New DDW 2026 Data on RINVOQ Just Changed What I'd Ask a GI

If your loved one has perianal fistulizing Crohn's, here's the short answer first: the DDW 2026 trial data on upadacitinib (RINVOQ) showed meaningful fistula closure rates in patients who hadn't responded to prior biologics — and it's worth bringing to your next gastroenterology appointment. This doesn't replace your medical team's guidance, but it gives you something specific and evidence-informed to ask about.

Now let me tell you why this data made me sit up straighter.

---

When my husband was in the thick of his Crohn's disease — three surgeries, complications that nobody prepared us for — there were moments where it genuinely felt like the options had run out. That feeling of hitting a wall is something I hear from families constantly. And it's nowhere more acute than in perianal fistulizing Crohn's, one of the most painful, most stigmatised, and most undertreated manifestations of this disease.

So when the DDW 2026 data on RINVOQ landed, I read it carefully. Not as a headline. As a naturopath and a Crohn's mum who knows exactly what it feels like to be sitting in a waiting room wondering if there's anything left to try.

Bright photograph of a white ceramic mug of tea on a light wood table beside an open notebook and pen, bright natural daylight, cream and white tones, no text

## What Is Perianal Fistulizing Crohn's — and Why Is It So Hard to Treat?

Perianal fistulas are abnormal tunnels that form between the intestine and the skin around the anus. They're a complication of Crohn's disease — not Ulcerative Colitis — and according to the Crohn's & Colitis Foundation, they affect up to 26–34% of people with Crohn's disease over the course of their lifetime.

Key takeaway: Perianal fistulas are not just a "skin issue" — they reflect deep transmural inflammation and are associated with more aggressive disease course, higher surgical rates, and significantly reduced quality of life.

They're also notoriously difficult to close. The gold standard for years has been a combination of anti-TNF biologics (like infliximab) plus surgical intervention — setons, fistulotomy, advancement flaps. Even with optimal treatment, complete fistula closure rates with infliximab alone sit around 30–40% in clinical trials. Many patients cycle through multiple treatments without achieving sustained closure.

This is the gap that makes the new RINVOQ data worth paying attention to.

## What Did the DDW 2026 Trial Data Actually Show?

The data presented at Digestive Disease Week (DDW) 2026 focused on upadacitinib — a JAK1-selective inhibitor marketed as RINVOQ — in patients with moderate-to-severe Crohn's disease, including a specific analysis of those with perianal fistulizing disease.

Here's what the data showed, in plain language:

Fistula closure rates: A meaningful proportion of patients with draining perianal fistulas at baseline achieved clinical fistula closure — defined as no draining fistulas on gentle compression — at both induction and maintenance timepoints. The closure rates observed were notably higher than historical benchmarks for anti-TNF therapy alone, particularly in patients who had already failed one or more prior biologics.

Bio-failure population: This is where it gets clinically significant. A substantial portion of the trial population had already tried and not responded to anti-TNF or anti-integrin biologics. Seeing meaningful fistula response in this group is important — because these are often the patients who feel like they've run out of road.

Safety profile: The safety signals were consistent with the known profile of upadacitinib in IBD — which includes considerations around infection risk, herpes zoster reactivation, and cardiovascular factors. Your gastroenterologist will weigh these carefully against your individual history. This is not a medication to start without specialist oversight.

What the data doesn't tell us: Trial data shows what happened in a controlled research population. It doesn't tell us how an individual patient — with their specific disease history, comorbidities, prior treatments, and surgical anatomy — will respond. That's a conversation for your GI team.

Light and airy close-up of a glass of water and a small lined notepad with a pen resting on a sunlit white marble surface, soft natural light, no text, no faces

## Why This Matters Even If You're Not on RINVOQ

As a naturopath, I always come back to this: new trial data doesn't just matter for the people who end up on that specific medication. It matters because it shifts the conversation.

For years, families navigating perianal fistulizing Crohn's have been told — sometimes gently, sometimes bluntly — that fistula closure is unlikely, that management is the goal rather than resolution, and that surgery is often the endpoint. This data challenges that framing.

And that matters for three reasons:

1. It gives you language. Walking into a GI appointment and saying "I read about the DDW 2026 upadacitinib fistula data — am I a candidate, or is there a reason we haven't discussed JAK inhibitors?" is a completely different conversation than "what else can we try?" Specificity gets you further.

2. It signals a direction of travel. The IBD treatment landscape is moving toward more targeted mechanisms. JAK inhibitors, S1P modulators, IL-23 inhibitors — the pipeline is active. If RINVOQ isn't right for your situation, something else in this class may be.

3. It validates that fistula closure is a legitimate treatment goal. For too long, patients with perianal disease have been told to manage expectations. This data supports advocating for closure — not just comfort — as a measurable outcome worth pursuing.

From a naturopathic perspective, I'd also add: whatever the medical treatment plan looks like, there are evidence-informed supportive strategies that can run alongside it. Nutritional support for tissue healing, targeted probiotics that have been studied in IBD, stress physiology work — none of these replace the medical plan, but they support the body's capacity to respond to it. This is something I work through with families individually.

Overhead flat lay of a small green plant, a white ceramic bowl, and a linen cloth on a bright white surface, natural daylight, soft sage and cream tones, no text

## Questions Worth Asking Your Gastroenterologist

If you or someone you love has perianal fistulizing Crohn's, here are specific questions to bring to your next appointment:

- "Have you seen the DDW 2026 data on upadacitinib for fistulizing disease? Is this something worth discussing for my situation?"

- "What's the current treatment goal for my fistulas — closure, or management? And what would it take to pursue closure more aggressively?"

- "Am I a candidate for a JAK inhibitor, and if not, what's the reason?"

- "Is there a role for combination therapy — biologic plus surgical intervention — that we haven't fully explored?"

- "What does the MRI of my fistula tract show, and how is that informing the treatment plan?"

These aren't confrontational questions. They're the questions of an informed advocate — which is exactly what your loved one needs you to be.

## Common Questions

What is upadacitinib (RINVOQ) and how does it work for Crohn's?

Upadacitinib is a JAK1-selective inhibitor that works by blocking specific inflammatory signalling pathways involved in Crohn's disease. It's approved for moderate-to-severe Crohn's in many countries and is being studied specifically for perianal fistulizing disease.

Is RINVOQ safe for Crohn's patients?

The safety profile of upadacitinib in IBD is well-characterised in clinical trials, but it carries risks including infection susceptibility and cardiovascular considerations that must be assessed individually by your gastroenterologist. It is not suitable for everyone.

Can perianal fistulas actually close with medication?

Yes — clinical fistula closure is a recognised and measurable outcome in Crohn's trials. Complete closure rates vary by treatment and patient population, but the DDW 2026 data suggests higher closure rates with upadacitinib than have been seen historically with anti-TNF therapy alone, particularly in biologic-experienced patients.

Should I ask my GI about switching to RINVOQ?

This is a conversation for your gastroenterologist, who knows your full history. What you can do is bring the DDW 2026 data to your appointment and ask whether it's relevant to your case. Being an informed advocate is always appropriate.

---

This article is for information and education only. It does not constitute medical advice and is not a substitute for guidance from your gastroenterologist or specialist medical team. Always work with your healthcare providers before making any changes to your treatment plan.

— Kate, The Crohn's Method