Rinvoq (Upadacitinib) - NICE approves new treatment for psoriatic arthritis

The tablet Janus Kinase (JAK) inhibitor treatment gets approval for psoriatic arthritis in adults in England and Wales.

The National Institute for Health and Care Excellence (NICE) has today published its decision to recommend the Janus Kinase (JAK) inhibitor Rinvoq (also known by its generic name, Upadacitinib) as a treatment option for adults with active psoriatic arthritis in England and Wales. This brings England and Wales in line with Scotland where the Scottish Medicines Consortium (SMC) approved Rinvoq for the treatment of psoriatic arthritis in May 2021.

The NICE guidance states that Rinvoq, alone or with methotrexate, is recommended as an option for treating active psoriatic arthritis in adults whose condition has not responded well enough to disease-modifying antirheumatic drugs (DMARDs) or who cannot tolerate these treatments, only if:

• The individual has peripheral arthritis with 3 or more tender joints and 3 or more swollen joints, and;
• They have had 2 conventional DMARDs and at least 1 biological DMARD or;
• Biologics from the tumour necrosis factor (TNF)-alpha inhibitor class are contraindicated (should not be used in this case) but would otherwise be considered (as described in NICE's technology appraisal guidance on etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis).

How does Rinvoq work?

Rinvoq belongs to a class of treatments known as Janus Kinase (JAK) inhibitors. Specifically, Rinvoq is a selective and reversible inhibitor of the Janus-associated tyrosine kinase, JAK1.

Cytokines are proteins that work in the immune system and play a key role in controlling cell growth and immune responses. It is thought that cytokines are over-active in people with psoriatic arthritis, leading to the overproduction of inflammation, which in turn causes the signs and symptoms of this condition.

Cytokines rely on a family of enzymes known as Janus Kinase (JAK) enzymes, to help them distribute their messages. Rinvoq blocks the activity of JAK enzymes, meaning that the inflammatory cycle of psoriatic arthritis is disrupted. Blocking the action of the JAK enzymes brings inflammation in the joints under control, leading to an improvement in symptoms of psoriatic arthritis for many people who take Rinvoq.

There is currently one other JAK inhibitor treatment available in the UK for people with psoriatic arthritis, called Xeljanz (Tofacitinib). 

How is Rinvoq used?

Rinvoq comes in tablet form and is taken orally once daily, with or without food, at a dose of 15mg. It may be taken at any time of the day.

Tablets should be swallowed whole, with water, and should not be split, crushed, or chewed in order to ensure the entire dose is delivered correctly. Food or drink containing grapefruit should be avoided during treatment with Rinvoq.

People taking Rinvoq will have regular blood tests - usually carried out by Rheumatology Nurses, or by their own GP - to monitor for possible effects of the treatment.

For more information on Rinvoq, please get in touch with us.