AbbVie announced that the U.S. Food and Drug Administration has approved a supplemental new drug application updating the indication statement for RINVOQ (upadacitinib) in inflammatory bowel disease treatment. The expanded label allows physicians to prescribe RINVOQ for adults with moderately to severely active ulcerative colitis and Crohn's disease after they have received at least one approved systemic therapy, specifically when tumor necrosis factor (TNF) blockers are deemed clinically inadvisable.
Expanded Treatment Positioning
Previously, RINVOQ was indicated only for IBD patients who had an inadequate response or intolerance to one or more TNF blockers. The updated indication provides an alternative pathway for patients who may not be suitable candidates for TNF blocker therapy from the outset.
"This label update gives healthcare providers the option to prescribe RINVOQ for patients with moderately to severely active inflammatory bowel disease after the use of one approved systemic therapy if TNF blockers are deemed clinically inadvisable by the prescribing physician," said Kori Wallace, M.D., Ph.D., vice president, global head of immunology clinical development at AbbVie.
Mechanism and Clinical Profile
RINVOQ is a JAK inhibitor discovered and developed by AbbVie scientists. In human leukocyte cellular assays, the drug inhibited cytokine-induced STAT phosphorylation mediated by JAK1 and JAK1/JAK3 more potently than JAK2/JAK2 mediated STAT phosphorylation. However, the relevance of inhibition of specific JAK enzymes to therapeutic effectiveness and safety is not currently known.
The drug is currently being studied in Phase 3 clinical trials for additional immune-mediated inflammatory diseases including alopecia areata, hidradenitis suppurativa, Takayasu arteritis, systemic lupus erythematosus, and vitiligo.
Safety Considerations
RINVOQ carries significant safety warnings, including increased risks of serious infections, death in patients 50 years and older with cardiovascular risk factors, certain cancers including lymphoma and skin cancers, major cardiovascular events, and blood clots. The drug can also cause serious allergic reactions and tears in the stomach or intestines.
Current or past smokers face higher risks for lymphoma and lung cancer, while patients 50 years and older with at least one heart disease risk factor have increased risks for cardiovascular events and blood clots.
Disease Impact
Inflammatory bowel disease encompasses chronic inflammatory conditions of the gastrointestinal tract, with Crohn's disease and ulcerative colitis being the most common forms. In both conditions, the immune system causes inflammation and damage to the gut mucosa. Crohn's disease typically manifests as inflammation within the GI tract, most commonly between the small intestine and colon, causing persistent diarrhea and abdominal pain. Ulcerative colitis causes continuous mucosal inflammation extending from the rectum to the proximal colon, with hallmark symptoms including rectal bleeding, abdominal pain, bloody diarrhea, and urgency.
Both diseases are progressive, potentially worsening over time and leading to life-threatening complications or surgery. The unpredictable nature of symptoms creates significant physical, emotional, and economic burdens for patients.
Patient Support Programs
AbbVie offers patient support programs including a co-pay card that may reduce out-of-pocket costs to $0 per month for eligible, commercially insured patients. Uninsured patients or those unable to pay for medication may be eligible for the company's Patient Assistance Program, myAbbVieAssist.
