Guideline-based Use of Upadacitinib: A Targeted Therapy for Immune-mediated Diseases

Course overview

Upadacitinib is a selective Janus kinase 1 (JAK1) inhibitor approved for multiple inflammatory conditions, including rheumatoid arthritis, psoriatic arthritis, atopic dermatitis, ulcerative colitis, Crohn's disease, axial spondyloarthritis, and giant cell arteritis. National and specialty guidelines consistently support its use as a second-line or advanced therapy following failure of conventional DMARDs or biologics. This once-daily oral agent offers rapid symptom control and mucosal healing in inflammatory bowel disease and demonstrates superior efficacy in some head-to-head trials against standard therapies. However, its use is associated with risks such as serious infections, malignancy, thrombosis, and major cardiovascular events. Safe prescribing requires careful screening, individualized dosing by indication and organ function, and ongoing monitoring by an interprofessional team.