Introduction

Upadacitinib (trade name: Rinvoq) has been approved in Germany since December 2019 for the treatment of moderate to severe rheumatoid arthritis in adults. It can be used either alone or in combination with methotrexate (MTX). Upadacitinib is an option if previous treatments with antirheumatic medications were not effective enough or if they were not well tolerated.

In rheumatoid arthritis, several joints are permanently inflamed and may become deformed and stiff over time. Muscles also become weaker. In advanced rheumatoid arthritis, stiff joints can make daily tasks difficult. Other symptoms such as pain and fatigue can be a big problem too.

Upadacitinib is classified as an immunosuppressant. Immunosuppressants are supposed to relieve inflammation in rheumatoid arthritis.

Application

Upadacitinib is taken once a day in the form of a 15 mg tablet.

Other treatments

In moderate to severe rheumatoid arthritis, various kinds of medication are used to relieve the symptoms, reduce the inflammation and to keep the joints working properly for as long as possible. There are two types of treatments: those that help to stop the condition from getting worse (disease-modifying), and those that are designed to relieve the symptoms (symptomatic).

Patients are typically first given conventional disease-modifying antirheumatic drugs (DMARDs) such as methotrexate, azathioprine, leflunomide, or sulfasalazine. If these conventional medications are no longer effective enough, biologic or synthetic disease-modifying drugs are used. The biologics include abatacept, etanercept, certolizumab pegol, golimumab, adalimumab and tocilizumab. Tofacitinib is an example of a synthetic disease-modifying drug (Janus kinase inhibitor, or JAK inhibitor). In severe rheumatoid arthritis, rituximab can be considered too.

Assessment

In 2020, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) looked into the advantages and disadvantages of upadacitinib compared with the standard treatments for moderate to severe rheumatoid arthritis.

The manufacturer provided suitable data for two groups of people:

  • First-line treatment with a biologic or synthetic disease-modifying antirheumatic drug (DMARD)
  • Subsequent treatment with a different biologic or synthetic disease-modifying antirheumatic drug (DMARD)

Learn more

More information

This information summarizes the main results of a review produced by the Institute for Quality and Efficiency in Health Care (IQWiG, Germany). The review was commissioned by the German Federal Joint Committee (G-BA) as part of the “early benefit assessment of medications.” On the basis of the review and the hearings received, the G-BA passed a resolution on the added benefit of upadacitinib (Rinvoq).