From the Guidelines
Remicade (infliximab) is likely a better choice than Rinvoq (upadacitinib) when bone healing is a primary concern, due to its neutral to potentially positive effect on bone healing. Both Remicade and Rinvoq may potentially impact bone healing, but through different mechanisms and possibly to different degrees. Remicade, a TNF-alpha inhibitor, generally has a neutral to potentially positive effect on bone healing in most patients, as excessive TNF-alpha can actually impair bone formation, so blocking it with Remicade may not significantly hinder healing and might even be beneficial in some inflammatory conditions 1. Rinvoq, as a JAK inhibitor, may have more concerning effects on bone healing since the JAK-STAT pathway plays important roles in osteoblast function and bone formation. Limited clinical data suggests JAK inhibitors might delay fracture healing or increase fracture risk. If bone healing is a primary concern (such as after recent surgery or with a fresh fracture), discussing with your healthcare provider about potentially continuing Remicade rather than switching to Rinvoq might be prudent. Some key points to consider when making treatment decisions include:
- The timing of surgery relative to medication dosing
- The specific condition being treated
- Individual patient factors Neither medication absolutely contraindicates necessary surgeries, but surgical timing and medication management should be optimized when possible. It's also worth noting that the most recent and highest quality study on the comparative efficacy of advanced therapies for management of moderate-to-severe ulcerative colitis, published in 2024, does not provide direct evidence on the effects of Remicade and Rinvoq on bone healing, but it does highlight the importance of considering the potential benefits and harms of different treatments in the context of individual patient needs 1.
From the Research
Comparison of Remicade and Rinvoq on Bone Healing
- The provided studies do not directly compare Remicade (infliximab) and Rinvoq (upadacitinib) in terms of their effects on bone healing.
- However, the studies do provide information on the effects of upadacitinib on bone healing in patients with rheumatoid arthritis.
- According to the study 2, upadacitinib was shown to inhibit radiographic progression in patients with rheumatoid arthritis, which suggests that it may have a positive effect on bone healing.
- The study 3 also found that upadacitinib inhibited radiographic progression in patients with rheumatoid arthritis, and that this effect was maintained over a period of 48 weeks.
- The study 4 reported that upadacitinib continued to show numerically better clinical responses than adalimumab over a period of 3 years, including inhibition of radiographic progression.
- The study 5 noted that upadacitinib was associated with an increased risk of herpes zoster and creatine phosphokinase elevations compared to methotrexate and adalimumab, but otherwise had a comparable safety profile.
- The study 6 found that upadacitinib improved patient-reported outcomes, including pain and functional ability, compared to placebo and adalimumab.
Effects of Upadacitinib on Bone Healing
- Upadacitinib has been shown to inhibit radiographic progression in patients with rheumatoid arthritis, which suggests that it may have a positive effect on bone healing 2, 3, 4.
- The exact mechanisms by which upadacitinib affects bone healing are not fully understood, but it is thought to involve the inhibition of pro-inflammatory cytokines and the promotion of anti-inflammatory cytokines.
- Further studies are needed to fully understand the effects of upadacitinib on bone healing and to compare its effects to those of other medications, such as Remicade.