Upadacitinib: Brands, Price & Uses in Bangladesh

Upadacitinib is a Janus kinase (JAK) inhibitor approved for the treatment of several chronic inflammatory and autoimmune conditions. Its indications are classified below by strength of evidence.

Established / FDA-approved indications

• Moderately to severely active rheumatoid arthritis (RA) in adults with an inadequate response or intolerance to one or more tumor necrosis factor (TNF) blockers, usually used in combination with or following methotrexate/other conventional DMARDs.
• Active psoriatic arthritis (PsA) in adults with inadequate response or intolerance to one or more TNF blockers.
• Active ankylosing spondylitis (AS) in adults with inadequate response or intolerance to TNF blockers.
• Active non-radiographic axial spondyloarthritis (nr-axSpA) with objective signs of inflammation, in adults with inadequate response or intolerance to TNF blockers.
• Moderately to severely active ulcerative colitis (UC) in adults with inadequate response, loss of response, or intolerance to one or more TNF blockers.
• Moderately to severely active Crohn's disease (CD) in adults with inadequate response, loss of response, or intolerance to one or more TNF blockers.
• Refractory, moderate to severe atopic dermatitis in adults and pediatric patients 12 years of age and older whose disease is not adequately controlled with other systemic therapies, including biologics, or when those therapies are not advisable.

Important limitation

Upadacitinib is generally reserved for patients who have already tried and had an inadequate response to a TNF blocker; it is not recommended in combination with biologic DMARDs, other JAK inhibitors, or potent immunosuppressants such as azathioprine or cyclosporine.

General principles

Before starting Upadacitinib, patients must be screened for active and latent tuberculosis, viral hepatitis, and baseline blood counts and liver function; vaccinations should be brought up to date. Upadacitinib extended-release tablets should be swallowed whole with or without food, at approximately the same time each day, and must not be split, crushed, or chewed.

Dosing by indication

Renal and hepatic adjustment

No dose adjustment is needed for RA, PsA, AS, or nr-axSpA in mild-to-moderate renal or hepatic impairment. For severe renal impairment, lower induction doses are used for ulcerative colitis and Crohn's disease as directed by the prescriber. Upadacitinib is not recommended in severe hepatic impairment (Child-Pugh C) or end-stage renal disease. See Contraindications and Precautions for infection screening requirements.

Common side effects

• Upper respiratory tract infections
• Nausea
• Cough
• Headache
• Fever (pyrexia)
• Acne
• Herpes zoster (shingles) and herpes simplex reactivation
• Elevated blood cholesterol/lipids
• Elevated liver enzymes

Less common but serious side effects

• Serious infections, including tuberculosis reactivation and opportunistic infections
• Low neutrophil, lymphocyte, or red blood cell counts (neutropenia, lymphopenia, anemia)
• Venous and arterial thrombosis (deep vein thrombosis, pulmonary embolism)
• Major adverse cardiovascular events (heart attack, stroke)
• Malignancies, including lymphoma and lung cancer
• Gastrointestinal perforation (particularly in ulcerative colitis patients with diverticular disease)
• Serious hypersensitivity reactions (including anaphylaxis)

Patients should seek prompt medical attention for signs of infection, unusual bleeding/swelling in a limb, chest pain, shortness of breath, or sudden severe abdominal pain while taking Upadacitinib.