Can Rinvoq (upadacitinib) cause respiratory infections and what is the management approach if an infection occurs?

Rinvoq (Upadacitinib) and Respiratory Infections: Risk and Management

Yes, Rinvoq (upadacitinib) can cause respiratory infections, and if one occurs, you should temporarily discontinue the medication until the infection resolves and contact your healthcare provider immediately for appropriate antibiotic treatment.

Risk of Respiratory Infections with Rinvoq

Rinvoq (upadacitinib) is a JAK-1 inhibitor that works by modulating the immune system, which inherently carries a risk of increased infections, including respiratory infections. According to the FDA drug label, respiratory infections are among the most commonly reported adverse events in patients taking Rinvoq 1.

Incidence of Respiratory Infections:

• Upper respiratory tract infections occur in approximately 9-20% of patients taking Rinvoq 1, 2
• In clinical trials for ulcerative colitis, upper respiratory tract infections were reported in 9% of patients receiving Rinvoq 45 mg compared to 7% on placebo 1
• In maintenance studies, upper respiratory tract infections occurred in 16-20% of patients on Rinvoq compared to 18% on placebo 1
• In real-world studies, respiratory tract infections accounted for approximately 10% of all adverse events reported with Rinvoq 3

Management of Respiratory Infections During Rinvoq Treatment

Immediate Steps When Infection Occurs:

1. Contact your healthcare provider immediately if you develop signs of infection such as fever, cough, shortness of breath, or other respiratory symptoms 4
2. Temporarily discontinue Rinvoq until the infection resolves 4, 1
3. Seek appropriate antibiotic treatment as prescribed by your healthcare provider 4

Monitoring Recommendations:

• Monitor body temperature frequently and report fever to your physician immediately 4
• Report any signs of infection such as cough, fever, chills, shortness of breath, or changes in breathing 4
• Clinical effect of antibiotic treatment should be expected within 3 days; contact your doctor if improvement is not noticeable 4

When to Seek Urgent Medical Care:

• If fever exceeds 4 days
• If breathing difficulties worsen
• If you stop drinking fluids
• If consciousness is decreasing 4

Prevention Strategies

Before Starting Rinvoq:

• Screen for tuberculosis, hepatitis, and HIV before initiating therapy 4
• Consider pneumococcal vaccination before starting treatment 4
• Annual influenza vaccination is recommended 4

During Treatment:

• Practice good hand hygiene
• Avoid close contact with people who have active infections
• Report any early signs of infection to your healthcare provider

Special Considerations

Risk Factors for Severe Infections:

• Age over 65 years
• Comorbidities such as COPD, diabetes, heart failure
• Previous hospitalization in the past year
• Use of oral glucocorticoids
• Previous antibiotic use in the last month 4

When to Consider Hospital Referral:

Referral to hospital should be considered for patients with:

1. Severe symptoms (tachypnea, tachycardia, hypotension, confusion)
2. Failure to respond to antibiotic treatment
3. Elderly patients with elevated risk of complications
4. Relevant comorbidities (diabetes, heart failure, COPD, liver disease, renal disease, malignancy) 4

Conclusion

While Rinvoq is effective for its approved indications, the risk of respiratory infections requires vigilance. The key to managing this risk is prompt recognition of infection symptoms, temporary discontinuation of the medication, and appropriate antibiotic treatment. Always maintain open communication with your healthcare provider about any symptoms that may indicate an infection.