Upadacitinib (Rinvoq)


Upadacitinib (Rinvoq) is an oral medication used to treat adults with moderate to severe active rheumatoid arthritis (RA), active psoriatic arthritis (PsA), active Ankylosing spondylitis (AS), active non-radiographic axial spondyloarthritis (nr-axSpA), moderate to severely active Crohn’s disease, moderate to severely ulcerative colitis (UC), and adults and children (12 years of age and older) with refractory moderate to severe atopic dermatitis (AD). It works by blocking enzymes called Janus kinases (JAKs). JAKs play an important role in joint inflammation, which can cause pain, swelling, and stiffness. Upadacitinib can be used after methotrexate and tumor necrosis factor inhibitors have been tried, or when these other medications would not be recommended for a patient.

How to Take It

Upadacitinib is a tablet that is taken once per day. Taking upadacitinib with food may decrease nausea or other gastrointestinal distress you may feel. Upadacitinib may be used alone or in combination with methotrexate or other conventional disease modifying antirheumatic drugs (cDMARDs). Upadacitinib should not be given in combination with another biologic drug or other medications that lower your immune system. Some patients will start to see improvement within a few weeks, but it may take several months to take full effect.

Side Effects

Upadacitinib can weaken your immune system. If you develop symptoms of an infection while using this medication, you should contact your doctor. All patients should be tested for tuberculosis before starting on upadacitinib and be screened for hepatitis B and shingles prior to starting, since this medication may increase risk of these infections if you are a carrier. Upadacitinib increases your chance of getting shingles so talk to your doctor about a vaccine for shingles. In patients over 50 years of age with at least one heart disease risk factor (such as smoking, history of heart attack, obesity, high blood pressure, high cholesterol), upadacitinib carries a warning for increased risk of heart attacks, strokes, and blood clots because it works like other medications that have caused those events. A rare complication seen with upadacitinib in clinical trials was bowel perforation, or a hole in the bowel wall, and cancer. Blood tests will be used to monitor for increases in cholesterol or liver enzymes and for reductions in blood cell counts while taking upadacitinib.

Tell Your Rheumatology Provider

If you develop symptoms of an infection such as a fever or cough, or allergic reactions, or think you are having any side effects (especially stomach pain, blood in the stool), contact your rheumatologist. Let your doctor know if you have a history of diverticulitis or serious infections. Tell your doctor if you become pregnant, are planning pregnancy, or if you are breastfeeding, as the medicine has not been determined to be safe for pregnancy. Ask your doctor about getting appropriate vaccines before starting upadacitinib and avoid live vaccines like the nasal spray flu vaccine, and others such as the measles, mumps, rubella, and yellow fever vaccines. Be sure to talk with your doctor before undergoing any surgeries while taking this medication.

Written March 2024 by Wendy Ramey, BSPharm, RPh, CSP, and reviewed by the American College of Rheumatology Communications and Marketing Committee.

This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis, and treatment of a medical or health condition.

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