Does Rinvoq Increase Infection Risk?
Yes, Rinvoq (upadacitinib), a Janus kinase (JAK) inhibitor used for rheumatoid arthritis, psoriasis, and other inflammatory conditions, increases the risk of serious infections. This occurs because it suppresses parts of the immune system, making users more susceptible to bacterial, viral, fungal, and opportunistic infections like tuberculosis or herpes zoster.[1][2]
Common Infections Linked to Rinvoq
Patients on Rinvoq report higher rates of upper respiratory infections, pneumonia, urinary tract infections, and shingles. Clinical trials showed infection rates of 40-50% in treated groups versus 30-35% in placebo, with serious infections in about 3-5% of users.[2][3] Real-world data from post-marketing studies confirm similar patterns, especially in those over 65 or with comorbidities.[1]
Why Does It Happen?
Rinvoq blocks JAK enzymes involved in immune signaling, reducing inflammation but also impairing the body's ability to fight pathogens. The risk rises with higher doses (15-30 mg daily), longer use, or combination with other immunosuppressants like methotrexate.[2]
Who Faces Higher Risks?
- Elderly patients (infection risk doubles over age 65).[1]
- Those with diabetes, lung disease, or prior infections.[3]
- Smokers or immunocompromised individuals.[2]
Screening for latent TB and hepatitis B is required before starting.[1]
How Does Rinvoq Compare to Other JAK Inhibitors?
Rinvoq carries similar warnings to Xeljanz (tofacitinib) and Olumiant (baricitinib), but FDA data shows slightly higher serious infection rates with Rinvoq (4.1 per 100 patient-years) versus Xeljanz (3.1).[3] All three have boxed warnings for infections, thrombosis, and malignancy.
What Precautions Do Doctors Recommend?
Monitor for infection signs like fever or cough; avoid live vaccines. Discontinue if serious infection develops. The label advises against use in active infections.[1][2] Patient registries track long-term risks.
Alternatives with Lower Infection Risk?
TNF inhibitors like Humira or Enbrel have lower serious infection rates (2-3 per 100 patient-years) but different efficacy profiles. Steroid-sparing options or biologics may suit high-risk patients better.[3]
[1]: Rinvoq Prescribing Information (AbbVie)
[2]: FDA Label for Upadacitinib
[3]: FDA Post-Marketing Safety Review: JAK Inhibitors