Does Rinvoq Increase Shingles Risk?
Rinvoq (upadacitinib), a JAK inhibitor for conditions like rheumatoid arthritis and ulcerative colitis, suppresses the immune system, raising the risk of infections including herpes zoster (shingles).[1][2] Clinical trials and post-marketing data show higher shingles incidence in Rinvoq users compared to placebo.
Shingles Rates in Rinvoq Studies
In rheumatoid arthritis trials, shingles occurred in 1.6-3.6% of Rinvoq patients (doses 15-30 mg) over 12-14 months, versus 0.5-1.3% on placebo or methotrexate.[1] Rates were dose-dependent and higher in patients over 65 or Asian populations.[2] Pooled ulcerative colitis data reported 2.6% incidence.[1]
| Study Population | Rinvoq Incidence | Comparator |
|------------------|------------------|------------|
| RA (15 mg) | 1.6-2.4% | 0.5-1.0% |
| RA (30 mg) | 3.0-3.6% | 1.3% |
| UC/PsA/Eczema | 1.5-4.0% | <1.0% |[1][2]
Why Does It Happen?
JAK inhibitors like Rinvoq block immune signaling, reactivating latent varicella-zoster virus (VZV) dormant after chickenpox.[3] Risk factors include age >50, prior immunosuppression, steroid use, or no shingles vaccine.[1]
Prevention and Management
CDC recommends Shingrix vaccine before starting Rinvoq; avoid live vaccines during treatment.[4] Doctors monitor for early shingles signs (rash, pain) and prescribe antivirals like valacyclovir if needed.[1] Discontinue Rinvoq for serious infections.[2]
Compared to Other JAK Inhibitors
Rinvoq's shingles risk aligns with Xeljanz (tofacitinib, 2-4%) and Olumiant (baricitinib, 1-3%), per FDA labels, but exceeds TNF inhibitors like Humira (<1%).[1][5]
Patient Reports and Long-Term Data
Real-world studies (e.g., ORAL Surveillance) confirm elevated risk persisting beyond 3 years, with 4-5% annual incidence in high-risk groups.[6] FDA updated Rinvoq labeling in 2021 with a boxed warning for infections, including shingles.[2]
[1]: Rinvoq Prescribing Information (AbbVie, 2023)
[2]: FDA Drug Safety Communication on JAK Inhibitors (2021)
[3]: NEJM: JAK Inhibitors and Herpes Zoster (2018)
[4]: CDC Shingrix Recommendations
[5]: Xeljanz Label (Pfizer)
[6]: Lancet: ORAL Surveillance Trial (2022)