Upadacitinib (Rinvoq) is an oral Janus kinase (JAK) inhibitor indicated for the treatment of various immune-mediated inflammatory diseases, such as rheumatoid arthritis, psoriatic arthritis, atopic dermatitis, ulcerative colitis, Crohn's disease, ankylosing spondylitis, non-radiographic axial spondyloarthritis, polyarticular juvenile idiopathic arthritis, and giant cell arteritis.
Dosage and Administration, Recommended Doses of Upadacitinib (Rinvoq)
Dosage Forms and Administration Routes
Upadacitinib is available in two dosage forms: extended-release tablets (15mg, 30mg, 45mg) and oral solution (1mg/mL).
The two dosage forms are not interchangeable; switching between them must be done under the guidance of a doctor.
Tablets should be swallowed whole and must not be split, chewed, or crushed.
The oral solution must be accurately measured using the accompanying syringe and taken twice daily.
Recommended Doses by Indication
Rheumatoid arthritis, ankylosing spondylitis, non-radiographic axial spondyloarthritis:
The recommended dose for adults is 15mg once daily.
Psoriatic arthritis:
Adults: 15mg once daily.
Children (2 to <18 years old): Dosage adjusted based on body weight; oral solution taken twice daily. For children with body weight ≥30kg, 15mg tablets taken once daily may be used.
Atopic dermatitis:
Adults and adolescents aged ≥12 years with body weight ≥40kg: Initial dose of 15mg once daily; if the response is insufficient, the dose may be increased to 30mg once daily.
Adults aged ≥65 years: Recommended dose of 15mg once daily.
Ulcerative colitis:
Adults (induction phase): 45mg once daily for 8 consecutive weeks.
Adults (maintenance phase): 15mg once daily; 30mg once daily may be considered for patients with severe or refractory disease.
Crohn's disease:
Adults (induction phase): 45mg once daily for 12 consecutive weeks.
Adults (maintenance phase): 15mg once daily; 30mg once daily may be considered for patients with severe or refractory disease.
Polyarticular juvenile idiopathic arthritis: Oral solution or tablets used based on body weight, taken once or twice daily.
Giant cell arteritis: Adults: 15mg once daily, combined with glucocorticoids (with gradual dose reduction).
Dose Adjustment of Upadacitinib (Rinvoq)
Adjustment Due to Infection or Laboratory Abnormalities
In case of severe infection, discontinue the medication until the infection is controlled.
If laboratory abnormalities occur, interrupt treatment until recovery.
Absolute neutrophil count <1000 cells/mm³.
Absolute lymphocyte count <500 cells/mm³.
Hemoglobin <8 g/dL.
Suspected drug-induced liver injury.
Patients with Renal Impairment
For conditions such as rheumatoid arthritis and psoriatic arthritis:
No dose adjustment is needed for mild to moderate renal impairment.
For severe renal impairment (eGFR 15-29): 15mg for patients with atopic dermatitis; 30mg during the induction phase and 15mg during the maintenance phase for patients with ulcerative colitis or Crohn's disease.
Use is not recommended for patients with end-stage renal disease (eGFR <15).
Patients with Hepatic Impairment
For mild to moderate hepatic impairment (Child-Pugh A/B):
No dose adjustment is needed for conditions such as rheumatoid arthritis.
For patients with ulcerative colitis or Crohn's disease: 30mg during the induction phase and 15mg during the maintenance phase.
Use is not recommended for patients with severe hepatic impairment (Child-Pugh C).
Medication for Special Populations of Upadacitinib (Rinvoq)
Pediatric Medication
Psoriatic arthritis, polyarticular juvenile idiopathic arthritis: Children aged ≥2 years receive doses based on body weight.
Atopic dermatitis: Indicated for adolescents aged ≥12 years with body weight ≥40kg.
The safety and efficacy of other indications in children have not been established.
Geriatric Medication
The efficacy of upadacitinib in elderly patients (≥65 years old) is comparable to that in younger patients, but the risks of infection and malignancy may be increased, especially when using the 30mg dose.
Individualized assessment is recommended, and a lower dose should be considered if necessary.
Pregnancy and Lactation
Pregnancy: Upadacitinib may cause harm to the fetus. Confirm no pregnancy before medication use; effective contraceptive measures must be taken during treatment and for 4 weeks after discontinuing the drug.
Lactation: Breastfeeding is not recommended; breastfeeding can be resumed 6 days after discontinuing the drug.
