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Rinvoq (Upadacitinib)

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Ulcerative Colitis
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MajorRad
Regular Member
Joined : Mar 2015
Posts : 29
Posted 9/26/2022 12:42 PM (GMT -8)
Well after 20 or so months of glorious endoscopic remission on Lialda and rectal tacrolimus ointment from Sept 2020 till about mid July 2022 we are back in a flare. Scope showed Mayo grade 2 from rectum to sigmoid, about 22 cm (at least the rest of my colon shows no inflammation). I have been on Humira (and flared) before. And rectal meds haven't done much frustratingly to calm the storm.

My GI recommended giving Rinvoq (Upadacitinib) a try. In his view it is more selective vs. Xeljanz (tofacitinib) and therefore maybe more effective with less side effects. Also its a once a day pill with no storage requirements. So that is nice.

Anyway I took the first dose two days ago. No effect yet. It does not look like many folks on here have tried it. I figured I would share my experience. Fingers crossed.
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FlowersGal
Veteran Member
Joined : Feb 2017
Posts : 1593
Posted 9/26/2022 1:57 PM (GMT -8)
Thanks for sharing! Will look forward to your updates as it is so new. Out of curiosity — how outrageously expensive is it?
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MajorRad
Regular Member
Joined : Mar 2015
Posts : 29
Posted 9/26/2022 2:09 PM (GMT -8)
It’s a lot I am sure.

I am “very lucky” in that I was diagnosed when I was active duty US military. Therefore, I can get care through the VA, so it is essentially zero cost
to me (I may have a co pay of $22 or something like that). Stay tuned…
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Sara14
Veteran Member
Joined : Mar 2007
Posts : 7543
Posted 9/26/2022 3:03 PM (GMT -8)
I get Xeljanz for free. I bet Rinvoq is free or a $5 copay with their patient assistance program. I hope it helps you! Xeljanz has me in nearly complete remission for the past year. Once daily pill is awesome! Xeljanz took me 9 weeks to get rid of all my symptoms.
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straydog
Forum Moderator
Joined : Feb 2003
Posts : 19268
Posted 9/27/2022 8:01 AM (GMT -8)
Good luck with Rinvog. Hugo18 is a member here & he is on Stelara & Rinvog & he is in remission. We have another member on it & doing well.

Please do keep us updated, as we don't hear much from the two members above.
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Hugo18
Regular Member
Joined : Mar 2017
Posts : 264
Posted 9/27/2022 2:19 PM (GMT -8)
yes, all the best luck. I am on both Stelera and Rinvoq. I have no idea which one is working or they are working in combination. I don't plan to alter anything after being in remission for over a year. So far every 18 months my body overrides my meds.
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MajorRad
Regular Member
Joined : Mar 2015
Posts : 29
Posted 10/9/2022 7:50 AM (GMT -8)
So 14 days in and things are much improved. I noticed improvement with in first 5-7 days actually. I am at the point where I can retain rectal meds again. At my GIs recommendation I restarted PR Uceris and Tacrolimus 6 days ago, both have added to the improvement and symptom wise I am near clinical remission. Plan is to taper Uceris first then Tacrolimus over the next 2-4 weeks and hopefully maintain remission on Rinvoq alone. Still no significant side effects or adverse reactions. I also got my Bivalent Covid booster and started the Singrix series. No issues with either of those.
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straydog
Forum Moderator
Joined : Feb 2003
Posts : 19268
Posted 10/9/2022 8:50 AM (GMT -8)
Great news to hear it's working for you. Hopefully the other issues will clear up soon & you will be on the road to remission.

Please keep your updates coming.
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FlowersGal
Veteran Member
Joined : Feb 2017
Posts : 1593
Posted 10/9/2022 9:10 AM (GMT -8)
Yes on the updates as it’s really good to hear progress reports on a new med!

Glad to hear you’re doing so well!
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Sara14
Veteran Member
Joined : Mar 2007
Posts : 7543
Posted 10/9/2022 12:14 PM (GMT -8)
Awesome. Happy for you.
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geezernow
Regular Member
Joined : Nov 2017
Posts : 309
Posted 10/11/2022 3:18 AM (GMT -8)
Major.....thank you for the updates! My doctor just prescribed Rinvoq for me yesterday. Now I'm sure the insurance wars shall begin again. Good luck and please keep posting updates.
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tonito
Regular Member
Joined : Jul 2011
Posts : 58
Posted 10/11/2022 10:18 AM (GMT -8)
Major Rad,

See my report on Rinvoq, which I just posted.
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MajorRad
Regular Member
Joined : Mar 2015
Posts : 29
Posted 10/11/2022 6:08 PM (GMT -8)
Saw it. Congrats! Hope to be following in your footsteps. Here’s to a long remission…
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barnsbury
Veteran Member
Joined : Jan 2006
Posts : 522
Posted 11/16/2022 11:19 AM (GMT -8)
Congrats on your remission. I was extremely unwell with UC for so long until Upadacitinib came along. Like you, I went into a fast remission and have remained that way since 2019. I am thankful.

A word of caution though. A recent scope found dysplasia which has significantly worsened the last few months. I have been informed that it was due to the Upadacitinib reactivating a HPV infection I had from many years ago, and the immune suppressing of this drug prevented my immune system from clearing the infection (as most healthy people would with no issues).

I had warts (GW) that stubbornly refused to away, despite intensive treatment. This was an early warning sign. So, be aware of any warts, etc, that you notice. I am sure you will be fine though.

Best wishes
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Sara14
Veteran Member
Joined : Mar 2007
Posts : 7543
Posted 11/16/2022 12:22 PM (GMT -8)
Where was the dysplasia? I've had HPV internally found on a scope in 2015. Had surgery to remove it in 2015, stayed away a few years, came back. Surgery to remove the condyloma again this year. All that to say I was only on Xeljanz the last year and this happened before I even started any biologics.

What are they doing for your dysplasia? Did they keep you on the Rinvoq?
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barnsbury
Veteran Member
Joined : Jan 2006
Posts : 522
Posted 11/16/2022 1:00 PM (GMT -8)
It was found in several places, mostly in the anal verge (severe) and extending up into the rectum and sigmoid. It is AIN3 and classed as High Grade (HPV 16). I have now had the dose of my drug dropped and I have already seen some of the warts disappearing. I am due to have laser ablation in December to remove the pre-cancerous lesions.

It is a complete nightmare and I am worried. But, at least it was picked up on a routine scope and I am now under the care of a great specialist.

There really should put this risk into the drug's patient information. As it only mentions Herpes. HPV is far more dangerous and clearly Upadacitinib (and other JAK inhibitors) create an environment for it to multiply.

I should also add I had the HPV vaccine a few years ago but as I already had the infection by then, it made zero difference.

Where was your dysplasia? How did the surgery and recovery go?
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Sara14
Veteran Member
Joined : Mar 2007
Posts : 7543
Posted 11/16/2022 2:16 PM (GMT -8)
Sorry, that really sucks. Oh, I don't have dysplasia, I just have had AIN 1 since 2015 (really do not like the word warts---condyloma is the word my surgeon always used, they're internal and I wouldn't even know they were there without a colonoscopy that found them). The surgery was just to remove condyloma. I'm not sure if it's what you're talking about, mine wasn't that high of a grade. My surgeon made it seem like the chance of getting anal cancer from HPV is so miniscule that I didn't even know why I was getting all these check-ups with her.

I've not heard there is any link specifically between JAK inhibitors though and HPV. You were also on prednisone for 10 years straight. I just don't know how we could say for sure what caused what and I've never had a doctor tell me JAK inhibitors do that. I had the vaccine after getting it as well....did nothing.

Anyway, good luck with your surgery!
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barnsbury
Veteran Member
Joined : Jan 2006
Posts : 522
Posted 11/16/2022 2:31 PM (GMT -8)
OK, well its good you only had AIN 1. I am 99% sure it was the upadacitinib that is the root cause of my AIN. I had annual scopes for most of the past 20 years and I never had dysplasia before. It was only after I started upadacitinib that the problems started. The condylomas (external) appeared. Loads of them. And even with multi treatment strategies, they would not go. Then AIN 2 got diagnosed after 2 years on upada. Now in Year 3, it progressed to AIN 3. I was never on Pred during these years....

Also, my Dr told me that he has several patients on immune suppression and all of them have complained about condylomas. As for JAK inhibitors, well, they are too new a drug for any proper research as their effect on HPV. We can only really go by personal experience I guess. In time, the link will be recognised though.

You are right the risk of anal cancer is small in the general population, but it is much greater in people with IBD/Lowered immunity/High risk HPV strains/Persistent infection. I fall into all 4 categories. sad

Post Edited (barnsbury) : 11/17/2022 4:37:46 AM (GMT-8)

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poopydoop
Veteran Member
Joined : Dec 2018
Posts : 1757
Posted 11/16/2022 7:00 PM (GMT -8)
Sorry to hear about this barnsbury, especially when you've been doing so well on upadacitinib.

I think it is a risk of most of the immunosuppressant drugs. My sister has a reactivated HPV infection (abnormal cells found during a routine smear test)..she never took a jak inhibitor but has been on several tnf-inhibitors and they were blamed for her inability to shake the hpv.
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Sara14
Veteran Member
Joined : Mar 2007
Posts : 7543
Posted 11/17/2022 10:13 AM (GMT -8)
That's weird. My doctors all said it's really rare to have this condyloma thing and I've looked all over the internet and never found anyone else who had it and IBD except you now. I even spoke to colo-rectal surgeons at Cleveland Clinic and University of Chicago (top medical centers for GI issues). I don't think your doctor knows what he is talking about. Anal cancer is still extremely, EXTREMELY low in people with IBD. Sorry, but you're spreading misinformation. My boyfriend has taken Xeljanz longer than me, has sex with me (a person with HPV), and he has never had a condyloma. So, if you want to do sample sizes of 1 or 2, there you go.
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MajorRad
Regular Member
Joined : Mar 2015
Posts : 29
Posted 11/17/2022 10:17 AM (GMT -8)
GTK barnsburry. Sorry to hear about the HPV.

Regarding Rinvoq, I am near the 8 week mark and things are still 80-90% better. 1-2 formed BMs with no urgency. Frustratingly, still a bit of blood. I probably tried to come off the rectal meds too quickly, so I am back on rectal tacrolimus ointment nightly.

I am scheduled to drop to 30mg Rinvoq dosing in a couple days so we will see what happens.
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Sara14
Veteran Member
Joined : Mar 2007
Posts : 7543
Posted 11/17/2022 10:19 AM (GMT -8)
I would not drop the dose until you're 100%. It took me 9 weeks to get to zero symptoms on Xeljanz. Maybe consider asking your doctor about staying on full dose a little longer, if you want.
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poopydoop
Veteran Member
Joined : Dec 2018
Posts : 1757
Posted 11/17/2022 1:45 PM (GMT -8)
I also waited 4 months before trying a dose reduction on xeljanz. I still had symptoms at 2 months, although we knew it was working
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MajorRad
Regular Member
Joined : Mar 2015
Posts : 29
Posted 11/17/2022 2:22 PM (GMT -8)
I did pose the question. My G.I. said unfortunately there is no data on whether 45mg taken longer is better than 30mg. It is clear however, that 30 is better than 15.

Anyway, I’m gonna stay the course and hopefully get to 100% soon
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geezernow
Regular Member
Joined : Nov 2017
Posts : 309
Posted 12/11/2022 7:27 AM (GMT -8)
MajorRad...how are things going with Rinvoq????
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