Summary

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• Rinvoq (upadacitinib) is approved for treating several inflammatory conditions, including rheumatoid arthritis, psoriatic arthritis, and ulcerative colitis, particularly in patients who have not responded well to TNF blockers. It is also indicated for moderate to severe atopic dermatitis in patients aged 12 and older when other treatments are inadequate. Additionally, it treats ankylosing spondylitis and non-radiographic axial spondyloarthritis in adults who have had insufficient response to TNF blockers.
• This summary is based on the review of 58 systematic review(s)/meta-analysis(es). ^[1-59]
• Atopic Dermatitis (AD): Upadacitinib 15 mg and 30 mg daily showed higher odds of achieving EASI 50, EASI 75, and EASI 90 compared to dupilumab, with upadacitinib 30 mg daily being the most effective, followed by abrocitinib 200 mg daily.
• Ulcerative Colitis (UC): Upadacitinib 30 mg/day was the most effective in achieving clinical remission in re-randomized patients with moderate to severe UC and was also more effective in achieving early symptomatic remission at weeks 2, 4, and 6 compared to other agents.
• Rheumatoid Arthritis (RA): Upadacitinib demonstrated higher ACR 20/50/70 response rates and clinical remission rates compared to other JAK inhibitors like tofacitinib and baricitinib in patients with inadequate responses to csDMARDs.
• Psoriatic Arthritis (PsA): Upadacitinib showed similar efficacy in achieving ACR20 and PASI75 outcomes compared to other b/tsDMARDs and also demonstrated substantial improvements in work productivity and activity impairment.
• Upadacitinib was associated with an increased risk of acne, nasopharyngitis, and elevated blood creatinine phosphokinase in atopic dermatitis patients, with no significant increase in serious infections, malignancies, or major cardiovascular events.
• In psoriatic arthritis, the safety profile of upadacitinib included a similar risk of adverse events and infections compared to other JAK inhibitors.
• Rheumatoid arthritis patients taking upadacitinib 30 mg daily experienced a higher incidence of infections and serious adverse events compared to other JAK inhibitors.
• There was an increased risk of herpes zoster associated with JAK inhibitors, particularly with upadacitinib and abrocitinib, with no significant increase in venous thromboembolism or cardiovascular events, although caution is advised for high-risk patients.
• Upadacitinib showed effectiveness in both adults and pediatric populations with AD, particularly in those resistant to other treatments. In PsA, improvements in work productivity were observed specifically in employed patients.
• Upadacitinib demonstrated notable efficacy in maintenance therapy for moderate to severe UC and was effective in RA patients with inadequate responses to both csDMARDs and bDMARDs.