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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 12/12/2022 9:38 PM (GMT -8)
So far so good. I feel like I am in clinical remission now, with the help of the rectal Tacrolimus (1.5mg at night). Going to stIll try and come off of that eventually, but more slowly this time (ie months rather than weeks).
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Sara14
Veteran Member
Joined : Mar 2007
Posts : 7644
Posted 12/13/2022 11:09 AM (GMT -8)
Glad you're doing well.
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A.Carter
New Member
Joined : Dec 2022
Posts : 10
Posted 1/4/2023 10:09 AM (GMT -8)
Hey bansbury (and others!) I have previously read through this thread as I started Rinvoq June 2022.
This morning I was trying to find this thread again because some of the side effects mentioned are possibly now appearing for me and I’m a bit worried.
I’m getting small painful wart like bumps on my fingers. But they disappear after a few days so not warts. Started with 1-2. They go away. Then I get a batch of more and they go away. Today I have 7- some appeared before my eyes. But concerned they are an early warning sign for something. Sometimes I just get a blotchy red rash on my hands.
My other side effects are acne and/or folliculitis on face/neck/arms/chest/entire back, it’s gotten to the point where I’m socially uncomfortable. Muscle soreness that I think I’ve noticed worsens when I don’t drink enough water. Lack of good hydration actually seems to worsen all my symptoms. My worry is from how RAPIDLY these side effects are progressing. Where will I be a month from now?
When I was on remicade lots my side effects were skin related too…bad dandruff around my hairline that came off in chunks, sometimes leaving red or small amounts of blood-I thought is was Psoriasis. Also some other symptoms but will not get into it. But I came off remicade shortly after symptoms got bad and all symptoms went away.
Anywho, I hope you continue to update this thread as you are paving the path of the unknowns of Rinvoq. I will express my concerns to my doctor, but they will surely be brushed aside with the response of “what is worse-these minor symptoms or flaring” which is agreeable, but side effects always scare me.
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geezernow
Regular Member
Joined : Nov 2017
Posts : 313
Posted 1/4/2023 8:03 PM (GMT -8)
A. Carter..please keep us updated on your side effects. I've been on Rinvoq now since Dec. 17th. Went into full remission really quickly and am doing great now. Only side effect so far is a little acne and really oily skin. Feel amazingly great and was able to enjoy the holidays without bathroom worries.
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barnsbury
Veteran Member
Joined : Jan 2006
Posts : 523
Posted 1/5/2023 5:40 AM (GMT -8)
Hi A Carter

Sorry to hear of your sides on the drug. It does appear that the sides are mostly minor, so I would try not worry too much about it. I am in remission, and I would much rather have the sides than be housebound and flaring and on Pred. I also have some acne from this drug and increased cholesterol.

That said, we still need to remain cautious. I am taking huge amounts of supplements and immune system boosters to keep the genital warts away, and thankfully they have stayed away. But, I know they could return at any time. I have had surgery to remove the first part of the anal dysplasia in December. And I will have another 3 surgeries in the next few months.
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Dandelion77
Regular Member
Joined : Nov 2017
Posts : 35
Posted 1/6/2023 4:31 PM (GMT -8)
Greetings all, I've been following this thread closely and am encouraged to read the progress some of you have had with Rinvoq. Because the med is so new, forums like this are a true gem.

I am 11 weeks in total (started 30 mg maintenance dose 12/14/22) and have been slowly tapering from a long run on prednisone (year +) while exploring treatment options. I had almost immediate symptoms improvement on the 45 mg loading dose or Rinvoq, which has been incredible. Nothing else has been this effective. Unfortunately, I have seen gradual flare-like symptoms return over the past two weeks or so. Hard to say if the transition from loading to maintenance dose, pred taper, or both are possible triggers. Then there's all the other factors (stress, diet, unknowns).


A little background: I was failed by both Humira and Remicade in the last two years. Disease "progressed" from moderate left-sided UC to severe following last my scope. My GI suggested we try Rinvoq as next treatment due to it being recommended to folks who do not respond well with anti-TNF meds. It's been a roller-coaster, as I'm sure you can relate! Since symptoms have returned, my GI recommended I go back up on prednisone (currently at 5 mg, which is negligible) to 20 mg and see what happens. I trust her judgement but it just feels like such a set-back, prolonging my hope to finally be free of steroid-dependency.

Curious to know if anyone has knowledge of people taking the loading dose beyond the recommended 8-week period, or returning to it due to situations like mine? I will stay cautiously optimistic that the increase in prednisone will allow for necessary healing so that Rinvoq alone is enough. Not too sure what is next if not...

Wishing all good health in the new year!

Danny
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A.Carter
New Member
Joined : Dec 2022
Posts : 10
Posted 1/6/2023 7:05 PM (GMT -8)
Hi Dandelion77
A couple months on Rinvoq and having “instant” recovery- also recently finished an 8 week taper off prednisone from 40mg- I remember messaging my doctor in panic because I thought I was having flare symptoms return. My doctor told me not to worry and said prednisone withdraw can have these symptoms. My symptoms were ear ringing & baaad joint pain (these are red flags for me and prelude my flares).

I think your doctor made a good call as well upping the prednisone. If the prednisone can keep the inflammation at bay while your colon heals enough then I’ll be hopeful with you that Rinvoq will be enough. That’s just my thinking -I’m no doctor smile

Someone in a post a started-asking if anyone had restarted Rinvoq- someone had after having to stop for a month for insurance reasons, and they believed they had to start again at the loading dose.

Barnsbury- thank you for responding back. I appreciate it. Best of luck with the upcoming surgeries. I go down the rabbit hole researching supplements sometimes. There are SO many and everyone has their own “miracle” cocktail they claim works. I’ll look around here for a good UC/supplements thread or info page. My friends and family probably consider me annoyingly healthy-but honestly I’m just terrified to trigger my UC. I would love to dig into what you and others are supplementing with.
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Dandelion77
Regular Member
Joined : Nov 2017
Posts : 35
Posted 1/7/2023 10:48 AM (GMT -8)
Thanks for your perspective and encouragement, A. Carter! I too am hopeful the increase in pred from 5 mg back up to 20 mg will nip the inflammation in the bud (maybe butt is more appropriate haha) for Rinvoq to work it's magic. Fingers crossed!

Wrote my GI yesterday to see if she's had any patients taking loading dose beyond 8 week mark, or returned to it when maintenance dose wasn't doing enough. Awaiting response, but I suspect the answer will be no.

Again, well wishes to all!
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barnsbury
Veteran Member
Joined : Jan 2006
Posts : 523
Posted 1/8/2023 3:51 AM (GMT -8)

Dandelion77 said...
Thanks for your perspective and encouragement, A. Carter! I too am hopeful the increase in pred from 5 mg back up to 20 mg will nip the inflammation in the bud (maybe butt is more appropriate haha) for Rinvoq to work it's magic. Fingers crossed!

Wrote my GI yesterday to see if she's had any patients taking loading dose beyond 8 week mark, or returned to it when maintenance dose wasn't doing enough. Awaiting response, but I suspect the answer will be no.

Again, well wishes to all!

Dandelion. Sorry to hear of your increase in symptoms. I think I have more experience with Rinvoq than anyone else on this forum. I was the first person to join the trial in the UK, and have been on the drug since 2018. It has been a godsend for me. This drug had to work or I would be going down the road of colectomy. Thankfully, I went into immediate remission and have stayed there mostly.

My journey is a bit complicated as I was on placebo controlled arm of the trial for quite a few months but went to open Label after I lost response (most likely because I was re-randomised into placebo in Phase 2). Like you, I was steroid dependent for many years and as I tapered off the Pred, my UC got worse, despite the Rinvoq. I was on 15mg and my Rinvoq dose was upped to 30mg daily. And my symptoms immediately went away. So, It looks like I needed the higher dose to get over the steroid withdrawal. But, I should have been moved back down to 15mg after that but they kept me on 30mg and that was the reason I got the warts. I know that now, as since I have been moved back down to 15mg, my warts have gone away. So, we need to be careful.

Secondly, I would strongly suggest you move to Hydrocortisone (the equivalent dose) and off Pred. I did this and it was a MASSIVE help in me getting off steroids. I was under the care of a Endocrinologist at my hospital who told me that it is so much easier to taper off Hydrocortisone than Pred, as the HC mimics the body natural steroid rhythm much more closely than Pred. It has a shorter half life compared to Pred. It forces your body to start creating its own steroid which doesnt happen so easily on Pred. So please look into making this change.

Hope this helps.

A Carter - I am on a host of supplements for the warts - Folate, Vit B12 Methylcobalamin. Shiitake Mushrooms. Multivitamin, Oregano Oil, Green Tea supplements, Artichoke Leaves, Lycopene.
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FlowersGal
Veteran Member
Joined : Feb 2017
Posts : 1631
Posted 1/8/2023 9:05 AM (GMT -8)
Just wanted to say thank you to you all! Since this is such a new med, posting your experiences here is invaluable to all of us UCers—no matter which drug we’re currently on—and especially those new to rinvoq!
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Dandelion77
Regular Member
Joined : Nov 2017
Posts : 35
Posted 1/9/2023 11:11 AM (GMT -8)
Thank you for sharing your thoughts and experiences, Barnsbury. Invaluable to have your insight with longterm experience on Rinvoq.

I have heard of folks transition to hydrocortisone when pred taper becomes challenging, but not very often. My GI has not suggested this approach so I'll be curious see what her take is. It's certainly proved to be a source of frustration and difficulty to navigate but Rinvioq has been a bit of light at the end of the UC tunnel. Just hopeful I can reach a point of healing to get away from steroid use all together!
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barnsbury
Veteran Member
Joined : Jan 2006
Posts : 523
Posted 1/9/2023 12:50 PM (GMT -8)

Dandelion77 said...
Thank you for sharing your thoughts and experiences, Barnsbury. Invaluable to have your insight with longterm experience on Rinvoq.

I have heard of folks transition to hydrocortisone when pred taper becomes challenging, but not very often. My GI has not suggested this approach so I'll be curious see what her take is. It's certainly proved to be a source of frustration and difficulty to navigate but Rinvioq has been a bit of light at the end of the UC tunnel. Just hopeful I can reach a point of healing to get away from steroid use all together!

I am happy to help! BTW, it wasn't my GI that suggested the switch to HC. Gastroenterologists are not specialists in this field. I was referred to an Endocrinologist (by my GI) and it was him that managed to get me off the Pred by moving me to HC. He is the expert after all. I should mention I also did a syancthen (sp) test which confirmed reduced adrenal gland function due to long term Pred use, Secondary Addisons disease I think it was classed as. But its all resolved now, thanks to my Endo moving me to HC. Still took many months on HC to taper off though.

I wish you all the best. Keep us informed of your progress.
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Dandelion77
Regular Member
Joined : Nov 2017
Posts : 35
Posted 1/13/2023 10:45 AM (GMT -8)
Ah yes, thank you for clarifying that barnsbury. I may explore having my GI refer me to an Endocrinologist if tapering from prednisone continues to be a challenge. I went back up to 20 mg (from 5 gm) on Jan. 7th and things have stabilized. It's a relief but I also recognize it as a kind of bandaid. The question remains if Rinvoq alone can manage my stubborn UC without steroids. Trying to be patient with the process, but the see-saw can be oh so frustrating!

Grateful for this forum
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tonito
Regular Member
Joined : Jul 2011
Posts : 58
Posted 1/13/2023 3:24 PM (GMT -8)
Here is a look at an interesting Poster from DDW 2022.

https://eposters.ddw.org/ddw/2022/ddw-2022/355635/tim.raine.impact.of.corticosteroid.usage.on.efficacy.and.safety.outcomes.in.html?f=listing%3D0%2Abrowseby%3D8%2Asortby%3D1%2Asearch%3Dupadacitinib
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tonito
Regular Member
Joined : Jul 2011
Posts : 58
Posted 1/13/2023 3:41 PM (GMT -8)
You can actually return to the 45 mg. induction strength if you flare at 30mg. This is more effective and safe than using prednisone either oral or rectal. That is the point of the poster I pasted above. So, I would ask your doctor if you can return to 45 mg. I am pasting below another study that showed that people who failed to reach remission at 45 mg. in the first 8 weeks were continued in that dose a little longer and many then achieved remission. It's right under Table 3 of the article. Hope this is helpful.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9211104/
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Sara14
Veteran Member
Joined : Mar 2007
Posts : 7644
Posted 1/14/2023 11:39 AM (GMT -8)
I've gone back up to the higher dose of Xeljanz several times for brief periods (less than a month). My doctor was fine with it.
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Dandelion77
Regular Member
Joined : Nov 2017
Posts : 35
Posted 1/19/2023 10:15 AM (GMT -8)
Good to know that, Sara. I am hopeful this can be a possible option for us folks taking Rinvoq. My GI said this is not something she's done with any patients yet and seemed keen on following a very slow pred taper schedule as a first choice of action. I so badly want off pred but am willing to give the taper one last whirl before I push the idea again of returning to Rinvoq loading dose. Fortunately, the increase from 5 - 20 mg pred has me in a much better place... now its a matter of if the pred can give my system the time it needs to heal without flare returning after tapering. Patience is the mantra!
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Leaher89
New Member
Joined : Jan 2023
Posts : 1
Posted 1/25/2023 8:12 AM (GMT -8)
Hi everyone. So grateful to have found this forum…I have been in a colitis flareup for over a year now after being in remission for 5 years while on Mesalamine. Both Entyvio and Remicade didn’t work for me, so I am about to try Rinvoq and am hoping for remission in order to be able to get pregnant again. I am currently on 25mg on prednisone that I’m guessing is keeping things slightly in check…not sure how much worse I’d feel if I weren’t on it! But I can’t wait to taper off the pred. I feel like I haven’t seen my real face in a year. My daughter is currently 20 months and it’s been so insanely difficult going through this flareup while trying to be a good stay at home parent!

Post Edited (Leaher89) : 1/25/2023 2:13:45 PM (GMT-8)

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geezernow
Regular Member
Joined : Nov 2017
Posts : 313
Posted 1/26/2023 4:03 AM (GMT -8)
Leaher....best of luck to you on Rinvoq. I've been on it since Dec. 17th. It's been working GREAT for me. The only side effect has been a bit of acne. THAT I can deal with much better than the problems of UC. I was in a flare when I first began Rinvoq. Within three days, ALL of my symptoms were just...gone. I thought it was just me and that it was all in my mind. LOL Then I read of several other folks who had about the same results. By far, Rinvoq has been the most effective drug I've taken since this mess began back in 1997. I will tell you, my insurance denied it for a while. With lots of help from my good doctor, they finally approved the prescription. Just hang in there and good luck. I thank ALL of the people who have posted about Rinvoq. It's a scary thing to begin a new drug and the posts on this forum certainly helped me a lot. Stay safe all and be well.
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Spring
Veteran Member
Joined : Jan 2017
Posts : 544
Posted 2/4/2023 6:03 PM (GMT -8)
Hi all, I started Rinvoq November 8th of 2022. I used to post on here quite a bit, but I had quite a health detour that took over my life as I had brain surgery 9.21 to remove an almost 1 inch tumor in my 4th ventricle. Thankfully I was pretty much UC symptom free at the time on Stelara, so did not have to deal with flaring and recovery from that at the same time. Last summer I had a month or two where I was having almost daily accidents, but I gained a couple of lbs, and my blood work looked good for me. After years of flaring on and off while on meds, I felt it was a mild flare. My GI insisted on a scope, as it had been several years. It took a while to get scheduled because originally the facility denied my procedure because apparently there is a tier system for what other health issues you have, and they were not equipped to deal with my secondary adrenal insufficiency. (long term steroid use, made worse by brain tumor that applied pressure to my hypothalmus) Anyways, we finally got me booked in at the hospital. I was surprised to hear I had moderate to severe disease activity halfway across my transverse colon. My GI gave me 6 weeks worth of Rinvoq 45 mg samples to get me started while they worked on insurance. They ended up giving me two more weeks of samples because they couldn't do just two weeks of 45 mg with my insurance. Insurance approved me to continue on 15 mg. I am doing well on it. It fairly quickly made me quit having more than the occasional odd accident. I was on Xeljance previously, and it only worked for about 5 months, so we shall see. I have noticed a bit of oily skin, and a little bit of acne. I occasionally get cold sores, but while on 45 mg I had to take the antiviral medication for them to go away, which I have never needed before. I am on fludrocortisone for extremely low blood pressure post brain surgery. I had my blood pressure go high after being on Rinvoq for close to the 8 weeks loading dose. I am not sure how much was Rinvoq vs stress of moving vs my brain adjusting again post surgery. I am now on half the fludrocortisone I was on before, but also am on 15 mg of Rinvoq instead of 45. I go next week to get labs done, so we shall see if it has caused other issues such as cholesterol elevation. I did experience crushing fatigue a couple of weeks in. I joined a fb Rinvoq group and learned there that people had less fatigue if they switched to night time. I did that, but what seemed to break me out of it was actually skipping 1 dose after switching. Maybe it was the combo? Dealing with fatigue again, and reflux issues that are making me lose my appetite. Sometimes sign of pre flare for me, but I also am on week two of anti seizure medication that can cause fatigue. (Thank you brain surgery) On the fb group, the main thing mentioned that hasn't been on this thread is heart issues in people over 50. I see a dermatologist yearly, and she just moved me to every 6 months. No skin cancer, but she did that after freezing off a second sunspot last visit. Said I was more at risk now.
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barnsbury
Veteran Member
Joined : Jan 2006
Posts : 523
Posted 2/5/2023 4:08 AM (GMT -8)
Hi Spring

Sorry to hear of your journey. Sounds awful. But, I am pleased to hear your UC is now in a better place. I am always happy of other people have success with Rinvoq.

Please do post back with your blood results. My cholesterol has been high since starting Rinvoq. I was on 30mg for years. I have now been on 15mg since last Summer and I was hoping my cholesterol levels would go down on the lower dose but unfortunately that hasnt happened. My skin is clearer though and no more warts.
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Spring
Veteran Member
Joined : Jan 2017
Posts : 544
Posted 3/8/2023 6:37 PM (GMT -8)
My last labs were good on the cholesterol front.
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geezernow
Regular Member
Joined : Nov 2017
Posts : 313
Posted 3/9/2023 7:03 AM (GMT -8)
Congratulations Spring!!!! After all you've been through, you certainly deserve some good news. LOL My Rinvoq is still working amazingly well. I too, had a bit of acne but I think it's finally subsiding. I hope you continue to do better and better. Be safe and stay well.
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CCinPA
Veteran Member
Joined : Dec 2014
Posts : 2518
Posted 3/9/2023 9:36 AM (GMT -8)
Good news on the labs, Spring! Hope your recovery from brain surgery is going well. That sounds like it was pretty scary!
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Spring
Veteran Member
Joined : Jan 2017
Posts : 544
Posted 3/9/2023 11:56 AM (GMT -8)
Thank you Geezernow and CCinPA. It was really rough. I honestly don't know which was worse, though, brain surgery, or the prednisone mistake that landed me in the hospital in the first place. I have been on and off steroids since diagnosis in 2017. I got to the point I couldn't get off of some daily low dose steroids to make up for my steroid suppresed endocrine system. Now we know my symptoms were from the brain tumor and adrenal insufficiency, but at the time I and my GI thought it was just the adrenal insufficiency. I would get better after taking extra, but didn't have enough to be taking the kind of doses I was needing. My GI told his MA to put in a prescription for 50 mgs of hydrocortisone, but he mentioned Prednisone, and the MA put in the script as 50 mg of Prednisone every 6 hours. I was hospitalized, and it took them 4 days to figure out I had some 300 mg of pred in my system, and that was causing psuedo seizures, and psychosis. (I probably would have been put in the same space if I ended up on a pred drip because of a flare) I can handle hydrocortisone now, but Pred puts me back into psychosis. Another UC med/typical treatment burned for me. Since Prednisone can cause psychosis, and can cause secondary adrenal insufficiency as a side affect, I am willing to share more if anyone has questions about either.
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