From the Guidelines
No, you should not take Xeljanz (tofacitinib) and Rinvoq (upadacitinib) at the same time. These medications are both Janus kinase (JAK) inhibitors that work through similar mechanisms to treat conditions like rheumatoid arthritis, psoriatic arthritis, and ulcerative colitis. Taking them together would essentially be doubling up on the same type of medication, which significantly increases the risk of serious side effects without providing additional therapeutic benefit. Both medications suppress the immune system, and using them concurrently could lead to severe immunosuppression, increasing your risk of serious infections, blood disorders, and potentially cancer. According to a consensus statement published in the Annals of the Rheumatic Diseases in 2021 1, JAK inhibitors have not been studied and are not recommended in combination with biologic disease-modifying antirheumatic drugs (bDMARDs) or potent immunosuppressive agents due to the possibility of increased immunosuppression and increased risk of infection or lymphoma. Additionally, guidelines for the management of psoriasis with systemic nonbiologic therapies, published in the Journal of the American Academy of Dermatology in 2020 1, recommend against combining tofacitinib with potent immunosuppressants or biologics used for psoriasis. If you're currently taking one of these medications and considering a change, you should work with your healthcare provider to safely discontinue one medication before starting the other, with an appropriate washout period between them. Your doctor can determine which JAK inhibitor might be more appropriate for your specific condition based on your medical history, disease activity, and previous treatment responses. Key considerations include:
- Increased risk of serious infections and blood disorders
- Potential for severe immunosuppression
- Lack of therapeutic benefit from combining JAK inhibitors
- Importance of working with a healthcare provider to safely switch between medications.
From the FDA Drug Label
RINVOQ is not recommended for use in combination with other JAK inhibitors, biologic disease-modifying antirheumatic drugs (DMARDs), or with potent immunosuppressants such as azathioprine and cyclosporine.
No, you should not take Xeljanz (tofacitinib) and Rinvoq (upadacitinib) at the same time, as both are JAK inhibitors and the label explicitly states that Rinvoq is not recommended for use in combination with other JAK inhibitors 2.
From the Research
Combination Therapy with Xeljanz and Rinvoq
There is no direct evidence to suggest that taking Xeljanz (tofacitinib) and Rinvoq (upadacitinib) at the same time is a recommended or safe treatment approach.
- The studies provided focus on the efficacy and safety of each medication individually or in comparison to other treatments, but not in combination with each other 3, 4, 5, 6, 7.
- Each of these medications is a Janus kinase (JAK) inhibitor, and they work by modulating the immune system to reduce inflammation in conditions like rheumatoid arthritis.
- The potential risks of combining two JAK inhibitors, such as increased risk of adverse events like infections, blood clots, or cardiovascular events, are not directly addressed in the provided studies.
- Studies like 5 and 6 compare the efficacy and safety of tofacitinib and upadacitinib separately, indicating they are both effective for treating rheumatoid arthritis but highlighting the need for more research on their comparative safety profiles.
Safety Considerations
Given the mechanism of action of both Xeljanz and Rinvoq as JAK inhibitors, there could be theoretical concerns about combining them due to potential additive effects on immune suppression and increased risk of adverse events.
- The FDA has issued warnings about the risks of serious heart-related events, cancer, blood clots, and death associated with JAK inhibitors like tofacitinib and upadacitinib 3.
- However, without specific studies examining the combination of Xeljanz and Rinvoq, the exact nature and extent of these risks when used together are unknown.
Clinical Decision Making
Healthcare providers must weigh the potential benefits against the risks when considering treatment options for patients with rheumatoid arthritis or other conditions where JAK inhibitors might be used.
- The decision to use one JAK inhibitor over another or to combine therapies should be based on individual patient factors, disease severity, response to previous treatments, and careful consideration of potential side effects.
- Further research, including head-to-head trials comparing different JAK inhibitors and studies on combination therapy, is needed to provide clearer guidance on the safest and most effective treatment strategies.