Rinvoq

— THERAPEUTIC CATEGORIES —
  • Arthritis/rheumatic disorders
  • Atopic dermatitis
  • Colorectal disorders

Rinvoq Generic Name & Formulations

General Description

Upadacitinib 15mg, 30mg, 45mg; ext-rel tabs.

Pharmacological Class

Janus kinase (JAK) inhibitor.

How Supplied

Ext-rel tabs 15mg, 30mg—30; 45mg—28

Manufacturer

Generic Availability

NO

Mechanism of Action

Upadacitinib modulates the signaling pathway at the point of JAKs, thus preventing the phosphorylation and activation of Signal Transducers and Activators of Transcription (STATs), which are modulators of intracellular activity including gene expression.

Rinvoq Indications

Indications

Active psoriatic arthritis (PsA), active ankylosing spondylitis (AS), or moderately to severely active rheumatoid arthritis (RA) in adults who have had an inadequate response or intolerance to 1 or more TNF blockers. Active non-radiographic axial spondyloarthritis (nraxSpA) in adults with objective signs of inflammation who have had an inadequate response or intolerance to TNF blocker therapy.

Limitations of Use

Not recommended in combination with other JAK inhibitors, biologic DMARDs, or potent immunosuppressants (eg, azathioprine, cyclosporine).

Rinvoq Dosage and Administration

Adult

Swallow whole. ≥18yrs: 15mg once daily. Concomitant strong CYP3A4 inhibitors: 15mg once daily; monitor. Dose interruption: see full labeling.

Children

<18yrs: not established.

Rinvoq Contraindications

Not Applicable

Rinvoq Boxed Warnings

Boxed Warning

Serious infections. Mortality. Malignancy. Major adverse cardiovascular events (MACE). Thrombosis.

Rinvoq Warnings/Precautions

Warnings/Precautions

Increased risk of serious infections (eg, TB, bacterial, viral, invasive fungal, or other opportunistic pathogens). Avoid in active, serious, or localized infections. Consider the risks/benefits in chronic, recurrent, or history of serious or opportunistic infections. Travel to, or residence in, areas with endemic TB or mycoses. Conditions that predispose to infection. Test/treat latent TB infection prior to and per applicable guidelines during therapy. Monitor closely if new infection, active TB (even if initial latent test is negative), reactivation of herpes virus or hepatitis occurs; interrupt treatment if serious or opportunistic infection. Screen for viral hepatitis before starting therapy. RA patients age ≥50yrs with ≥1 CV risk factor treated with another JAK inhibitor: increased rate of all-cause mortality (including sudden CV death), MACE (CV death, MI, stroke), or thrombosis. Discontinue in those with previous MI or stroke, or with symptoms of thrombosis. Avoid in those with increased risk for thrombosis. Increased rate of malignancies (esp. lymphomas, lung cancers). Consider benefits/risks prior to or continuing therapy (esp. smokers, with other CV risk factors, or with a known malignancy). GI perforation risk (eg, history of diverticulitis); monitor and evaluate promptly if new onset abdominal pain occurs. Perform periodic skin exam in those with skin cancer risk. Update immunizations based on current guidelines prior to initiation. Do not initiate therapy if lymphocytes <500cells/mm3, ANC <1000cells/mm3, or hemoglobin <8g/dL. Monitor lymphocytes, neutrophils, and hemoglobin at baseline, then periodically thereafter. Routinely monitor liver enzymes; interrupt therapy if ALT/AST elevated and drug-induced liver injury is suspected. Monitor lipids 12 weeks following initiation and manage hyperlipidemia. Medication residue in stool or ostomy output (monitor and consider alternative therapies if inadequate response). Severe hepatic impairment, ESRD (atopic dermatitis, UC): not recommended. Severe renal impairment (atopic dermatitis, UC): see Adult. Elderly. Embryo-fetal toxicity. Advise females of reproductive potential to use effective contraception during and for 4 weeks after the last dose. Pregnancy: exclude status prior to initiation. Nursing mothers: not recommended (during and for 6 days after the last dose).

Rinvoq Pharmacokinetics

Absorption

  • Median time to maximum concentration: 2–4 hours.

Distribution

  • 52% plasma protein bound.

Metabolism

  • CYP3A4 (major), CYP2D6.

Elimination

  • Fecal (38%), renal (24%).
  • Half-life: 8–14 hours.

Rinvoq Interactions

Interactions

Avoid concomitant live vaccines. Concomitant biologic DMARDs or potent immunosuppressants (eg, azathioprine, cyclosporine): not recommended. Avoid food or drink containing grapefruit. Potentiated by strong CYP3A4 inhibitors (eg, ketoconazole, clarithromycin); see Adult. Antagonized by strong CYP3A4 inducers (eg, rifampin); not recommended. Increased risk for GI perforation with concomitant use of NSAIDs, corticosteroids; monitor.

Rinvoq Adverse Reactions

Adverse Reactions

Upper respiratory tract infections, herpes zoster or simplex, bronchitis, nausea, cough, pyrexia, acne, headache; other serious or opportunistic infections, cytopenias, liver enzyme or lipid elevations, non-melanoma skin cancer, hypersensitivity reactions, medication residue in stool or ostomy output (monitor and consider alternative therapies if inadequate response).

Rinvoq Clinical Trials

See Literature

Rinvoq Note

Not Applicable

Rinvoq Patient Counseling

See Literature

Rinvoq Generic Name & Formulations

General Description

Upadacitinib 15mg, 30mg, 45mg; ext-rel tabs.

Pharmacological Class

Janus kinase (JAK) inhibitor.

How Supplied

Ext-rel tabs 15mg, 30mg—30; 45mg—28

Manufacturer

Generic Availability

NO

Mechanism of Action

Upadacitinib modulates the signaling pathway at the point of JAKs, thus preventing the phosphorylation and activation of Signal Transducers and Activators of Transcription (STATs), which are modulators of intracellular activity including gene expression.

Rinvoq Indications

Indications

In adults with refractory, moderate to severe atopic dermatitis whose disease is not adequately controlled with other systemic drug products, including biologics, or when use of those therapies are inadvisable.

Limitations of Use

Not recommended in combination with other JAK inhibitors, biologic immunomodulators, or with other immunosuppressants.

Rinvoq Dosage and Administration

Adult

Swallow whole. ≥12yrs (≥40kg): Initially 15mg once daily; if inadequate response, consider increasing to 30mg once daily. Use lowest effective dose needed to maintain response. For elderly (≥65yrs), severe renal impairment (CrCl <30mL/min), or concomitant strong CYP3A4 inhibitors: 15mg once daily. Dose interruption: see full labeling.

Children

<12yrs: not established.

Rinvoq Contraindications

Not Applicable

Rinvoq Boxed Warnings

Boxed Warning

Serious infections. Mortality. Malignancy. Major adverse cardiovascular events (MACE). Thrombosis.

Rinvoq Warnings/Precautions

Warnings/Precautions

Increased risk of serious infections (eg, TB, bacterial, viral, invasive fungal, or other opportunistic pathogens). Avoid in active, serious, or localized infections. Consider the risks/benefits in chronic, recurrent, or history of serious or opportunistic infections. Travel to, or residence in, areas with endemic TB or mycoses. Conditions that predispose to infection. Test/treat latent TB infection prior to and per applicable guidelines during therapy. Monitor closely if new infection, active TB (even if initial latent test is negative), reactivation of herpes virus or hepatitis occurs; interrupt treatment if serious or opportunistic infection. Screen for viral hepatitis before starting therapy. RA patients age ≥50yrs with ≥1 CV risk factor treated with another JAK inhibitor: increased rate of all-cause mortality (including sudden CV death), MACE (CV death, MI, stroke), or thrombosis. Discontinue in those with previous MI or stroke, or with symptoms of thrombosis. Avoid in those with increased risk for thrombosis. Increased rate of malignancies (esp. lymphomas, lung cancers). Consider benefits/risks prior to or continuing therapy (esp. smokers, with other CV risk factors, or with a known malignancy). GI perforation risk (eg, history of diverticulitis); monitor and evaluate promptly if new onset abdominal pain occurs. Perform periodic skin exam in those with skin cancer risk. Update immunizations based on current guidelines prior to initiation. Do not initiate therapy if lymphocytes <500cells/mm3, ANC <1000cells/mm3, or hemoglobin <8g/dL. Monitor lymphocytes, neutrophils, and hemoglobin at baseline, then periodically thereafter. Routinely monitor liver enzymes; interrupt therapy if ALT/AST elevated and drug-induced liver injury is suspected. Monitor lipids 12 weeks following initiation and manage hyperlipidemia. Medication residue in stool or ostomy output (monitor and consider alternative therapies if inadequate response). Severe hepatic impairment, ESRD (atopic dermatitis, UC): not recommended. Severe renal impairment (atopic dermatitis, UC): see Adult. Elderly. Embryo-fetal toxicity. Advise females of reproductive potential to use effective contraception during and for 4 weeks after the last dose. Pregnancy: exclude status prior to initiation. Nursing mothers: not recommended (during and for 6 days after the last dose).

Rinvoq Pharmacokinetics

Absorption

  • Median time to maximum concentration: 2–4 hours.

Metabolism

  • CYP3A4 (major), CYP2D6.

Elimination

  • Fecal (38%), renal (24%).
  • Half-life: 8–14 hours.

Rinvoq Interactions

Interactions

Avoid concomitant live vaccines. Concomitant biologic DMARDs or potent immunosuppressants (eg, azathioprine, cyclosporine): not recommended. Avoid food or drink containing grapefruit. Potentiated by strong CYP3A4 inhibitors (eg, ketoconazole, clarithromycin); see Adult. Antagonized by strong CYP3A4 inducers (eg, rifampin); not recommended. Increased risk for GI perforation with concomitant use of NSAIDs, corticosteroids; monitor.

Rinvoq Adverse Reactions

Adverse Reactions

Upper respiratory tract infections, acne, herpes simplex, headache, increased blood creatine phosphokinase, cough, folliculitis, nausea, abdominal pain, pyrexia, increased weight, herpes zoster, influenza, fatigue, neutropenia, myalgia, influenza-like illness; other serious or opportunistic infections, cytopenias, liver enzyme or lipid elevations, non-melanoma skin cancer, hypersensitivity reactions.

Rinvoq Clinical Trials

See Literature

Rinvoq Note

Not Applicable

Rinvoq Patient Counseling

See Literature

Rinvoq Generic Name & Formulations

General Description

Upadacitinib 15mg, 30mg, 45mg; ext-rel tabs.

Pharmacological Class

Janus kinase (JAK) inhibitor.

How Supplied

Ext-rel tabs 15mg, 30mg—30; 45mg—28

Manufacturer

Generic Availability

NO

Mechanism of Action

Upadacitinib modulates the signaling pathway at the point of JAKs, thus preventing the phosphorylation and activation of Signal Transducers and Activators of Transcription (STATs), which are modulators of intracellular activity including gene expression.

Rinvoq Indications

Indications

Moderately to severely active ulcerative colitis (UC) or moderately to severely active Crohn disease (CD) in adults who have had an inadequate response or intolerance to 1 or more TNF blockers.

Limitations of Use

Not recommended in combination with other JAK inhibitors, biological therapies for UC or CD, or with potent immunosuppressants (eg, azathioprine, cyclosporine).

Rinvoq Dosage and Administration

Adult

Swallow whole. ≥18yrs: Induction: 45mg once daily for 8 weeks (UC) and for 12 weeks (CD).  Maintenance (for both): 15mg once daily; may consider 30mg once daily for refractory, severe or extensive disease (discontinue if inadequate response with 30mg dose). Use lowest effective dose needed to maintain response. For severe renal impairment (CrCl 15–<30mL/min), mild to moderate hepatic impairment, concomitant strong CYP3A4 inhibitors: 30mg once daily for 8 weeks (induction for UC) and for 12 weeks (induction for CD); 15mg once daily (maintenance). Dose interruption: see full labeling.

Children

<18yrs: not established.

Rinvoq Contraindications

Not Applicable

Rinvoq Boxed Warnings

Boxed Warning

Serious infections. Mortality. Malignancy. Major adverse cardiovascular events (MACE). Thrombosis.

Rinvoq Warnings/Precautions

Warnings/Precautions

Increased risk of serious infections (eg, TB, bacterial, viral, invasive fungal, or other opportunistic pathogens). Avoid in active, serious, or localized infections. Consider the risks/benefits in chronic, recurrent, or history of serious or opportunistic infections. Travel to, or residence in, areas with endemic TB or mycoses. Conditions that predispose to infection. Test/treat latent TB infection prior to and per applicable guidelines during therapy. Monitor closely if new infection, active TB (even if initial latent test is negative), reactivation of herpes virus or hepatitis occurs; interrupt treatment if serious or opportunistic infection. Screen for viral hepatitis before starting therapy. RA patients age ≥50yrs with ≥1 CV risk factor treated with another JAK inhibitor: increased rate of all-cause mortality (including sudden CV death), MACE (CV death, MI, stroke), or thrombosis. Discontinue in those with previous MI or stroke, or with symptoms of thrombosis. Avoid in those with increased risk for thrombosis. Increased rate of malignancies (esp. lymphomas, lung cancers). Consider benefits/risks prior to or continuing therapy (esp. smokers, with other CV risk factors, or with a known malignancy). GI perforation risk (eg, history of diverticulitis); monitor and evaluate promptly if new onset abdominal pain occurs. Perform periodic skin exam in those with skin cancer risk. Update immunizations based on current guidelines prior to initiation. Do not initiate therapy if lymphocytes <500cells/mm3, ANC <1000cells/mm3, or hemoglobin <8g/dL. Monitor lymphocytes, neutrophils, and hemoglobin at baseline, then periodically thereafter. Routinely monitor liver enzymes; interrupt therapy if ALT/AST elevated and drug-induced liver injury is suspected. Monitor lipids 12 weeks following initiation and manage hyperlipidemia. Medication residue in stool or ostomy output (monitor and consider alternative therapies if inadequate response). Severe hepatic impairment, ESRD (atopic dermatitis, UC): not recommended. Severe renal impairment (atopic dermatitis, UC): see Adult. Elderly. Embryo-fetal toxicity. Advise females of reproductive potential to use effective contraception during and for 4 weeks after the last dose. Pregnancy: exclude status prior to initiation. Nursing mothers: not recommended (during and for 6 days after the last dose).

Rinvoq Pharmacokinetics

Absorption

  • Median time to maximum concentration: 2–4 hours.

Metabolism

  • CYP3A4 (major), CYP2D6.

Elimination

  • Fecal (38%), renal (24%).
  • Half-life: 8–14 hours.

Rinvoq Interactions

Interactions

Avoid concomitant live vaccines. Concomitant biologic DMARDs or potent immunosuppressants (eg, azathioprine, cyclosporine): not recommended. Avoid food or drink containing grapefruit. Potentiated by strong CYP3A4 inhibitors (eg, ketoconazole, clarithromycin); see Adult. Antagonized by strong CYP3A4 inducers (eg, rifampin); not recommended. Increased risk for GI perforation with concomitant use of NSAIDs, corticosteroids; monitor.

Rinvoq Adverse Reactions

Adverse Reactions

Upper respiratory tract infections, increased blood creatine phosphokinase, acne, neutropenia, rash; other serious or opportunistic infections, cytopenias, liver enzyme or lipid elevations, non-melanoma skin cancer, hypersensitivity reactions.

Rinvoq Clinical Trials

See Literature

Rinvoq Note

Not Applicable

Rinvoq Patient Counseling

See Literature