Upadacitinib

How it works

It preferentially inhibits JAK1, interrupting cytokine signal transduction through the JAK-STAT pathway and thereby dampening the inflammatory cascade that drives intestinal mucosal damage.

Prescribing in practice

• Serious and opportunistic infection is the dominant risk — screen for and treat latent tuberculosis and viral hepatitis before starting, and withhold during active serious infection.
• MHRA class advice for JAK inhibitors restricts use in those aged 65 or over, current or past long-term smokers and those with cardiovascular or malignancy risk factors, given increased risks of major cardiovascular events, malignancy and venous thromboembolism.
• Herpes zoster reactivation is notably increased, and live vaccines should be avoided during treatment.

Monitoring

Monitor full blood count, lipids and liver function, and remain vigilant for infection, thromboembolism and skin malignancy throughout treatment.

Counselling the patient

• Report signs of infection such as fever, persistent cough or a shingles-type rash promptly.
• Seek urgent help for symptoms of a clot, such as leg swelling, chest pain or sudden breathlessness.
• Keep up with skin checks and avoid live vaccines while taking this medicine.

Evidence & guidelines

Upadacitinib is recommended by NICE for ulcerative colitis and Crohn's disease, with MHRA safety measures applying across the JAK-inhibitor class.