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Drug Info

Does Rinvoq cause weight gain?

There’s more evidence of JAK inhibitors causing weight gain than Rinvoq itself
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By | Jul. 8, 2024 Medically reviewed by Josephine Bawab, Pharm.D.
A pill bottle with white tablets spilling out: Does Rinvoq cause weight gain?

Key takeaways

  • Rinvoq is a JAK inhibitor drug prescribed to treat rheumatoid arthritis, psoriatic arthritis, atopic dermatitis, nonradiographic axial spondyloarthritis, Crohn’s disease, and ulcerative colitis.

  • The drug may cause weight gain in some patients, but it depends on the person, their condition, and their other medications.

  • Other than causing weight gain, Rinvoq may also increase the risk of serious infections, blood clots, cardiovascular events, thrombosis, lymphomas, and pulmonary embolisms.

  • Patients can manage Rinvoq-related weight gain by consulting their healthcare provider, exercising, and maintaining a healthy diet.

In this article:

Inflammation is a double-edged sword. It’s part of the immune system’s defense mechanism, but it can cause serious issues—like rheumatoid arthritis and psoriatic arthritis—if it gets too severe. Rinvoq (upadacitinib) is a prescription medication that can treat these conditions, along with moderate to severe atopic dermatitis, ankylosing spondylitis, Crohn’s disease, and ulcerative colitis. And while it’s a powerful anti-inflammatory drug, Rinvoq may cause weight gain in some people. Exactly how, why, and when may vary, but we’ve got all the details below. 

Why does Rinvoq cause weight gain?

The Food and Drug Administration (FDA) prescribing information for Rinvoq states that, during clinical trials, Rinvoq only caused weight gain in around 2% of patients. This could simply stem from its drug type. Rinvoq is a Janus kinase (JAK) inhibitor, which means it blocks certain enzymes that cause the immune system to create inflammation. One study from 2019 demonstrated that 84% of patients taking JAK inhibitors saw increased body weight. However, the FDA only lists increased weight as a side effect when it’s used for atopic dermatitis—a type of eczema—not arthritis or other conditions.

Determining the cause of this weight increase when taking Rinvoq for atopic dermatitis is a little more complicated. “The mechanism behind this weight gain is not entirely clear,” explains Dr. John Lowe, MD, of Restore Care Wellness Clinic. “But, it may be related to changes in appetite or metabolic effects.”

In some cases, weight gain might not stem from Rinvoq itself, but from supplemental medications. Some atopic dermatitis patients take corticosteroids like prednisone as well, which may cause weight gain. Nonsteroidal anti-inflammatory drugs (NSAIDs) are another common companion, and although they don’t cause weight gain, they might cause fluid retention.

Even though JAK inhibitors and certain biologic drugs prescribed for inflammatory diseases may affect a patient’s weight, remember that everyone reacts to medications differently, so it depends entirely on the person.

Other Rinvoq side effects

According to Rinvoq’s manufacturer, AbbVie, other common side effects of Rinvoq include:

  • Upper respiratory tract infections
  • Shingles (herpes zoster)
  • Cold sores
  • Headache
  • Acne
  • Nausea
  • Fever
  • Sore throat
  • Inflamed hair follicles
  • Stomach pain
  • Tiredness
  • Decreased white blood cells
  • Muscle pain
  • Rash
  • High cholesterol levels
  • Increased liver enzyme levels
  • Pneumonia
  • Low red blood cell count (anemia)
  • Gastroenteritis

Dr. Lowe recommends that doctors monitor Rinvoq patients closely for any signs of weight gain, changes in body composition, or other side effects. 

Warnings and precautions

The FDA has also included a boxed warning on the Rinvoq extended-release tablet label for certain serious side effects. They include an increased risk of serious infections, blood clots, life-threatening cardiovascular events (e.g., heart attack and stroke), thrombosis, and higher rates of skin cancer, lymphoma, liver problems, and pulmonary embolisms. If you experience any symptoms of these conditions, including chest pain and trouble breathing, seek medical help immediately.

Rinvoq may also cause gastrointestinal perforations, which are small holes in the stomach, small intestine, or large intestine. These are rare, but they’re serious issues that require immediate treatment. Healthcare providers will monitor patients with diverticulitis or risk factors for perforations more closely while taking Rinvoq.

Beyond that, in rare instances, Rinvoq may cause allergic reactions. Anyone who experiences hives, shortness of breath, dizziness, faintness, or swelling of the lips, tongue, or throat should seek immediate medical attention.

Additionally, Rinvoq animal studies showed excretion of its active ingredient, upadacitinib, in breast milk and potential fetal malformations in early pregnancy. There are no current studies on human lactation or fetal development, but AbbVie advises against taking Rinvoq while pregnant or breastfeeding. It also recommends taking birth control to avoid pregnancy during treatment and four weeks after the last dose of Rinvoq since it may harm an unborn baby.

“When thinking about using Rinvoq as a treatment, it’s important to weigh the possible benefits against the risks and discuss other treatment options with patients,” Dr. Lowe says. “Depending on the patient’s condition and medical history, other options like different disease-modifying anti-rheumatic drugs (DMARDs), biologic agents, or nonpharmacological treatments may be considered.”

How to manage Rinvoq side effects

Weight gain from Rinvoq isn’t necessarily the result of any particular lifestyle choice. However, exercising regularly and sticking to a well-balanced diet may help manage it. “I recommend the Mediterranean diet to all my patients because it contains foods that are anti-inflammatory,” says rheumatologist Stella Bard, MD, a board-certified rheumatologist at a private practice in McKinney, Texas. “Conditions like spondyloarthritis are linked to obesity, and fat cells actually produce inflammatory cytokines. I often tell patients that shedding and ridding themselves of the troublemakers is half the battle.”

For pointed recommendations based on your specific condition, it’s best to speak with your healthcare provider. They can provide medical advice based on their knowledge of your specific situation. They might alter the dosage, present alternatives, or suggest seeing a dietitian or a different type of healthcare provider. 

Some of the other possible side effects may simply subside as your body adjusts to the treatment. For mild side effects like respiratory infections, headache, nausea, and acne, over-the-counter medications can work well—just consult your healthcare provider beforehand. And, if you experience the symptoms of any serious side effects or allergic reactions, see a healthcare professional as soon as possible.

Rinvoq alternatives

Dr. Bard says some of the most common Rinvoq alternatives are “other JAK inhibitors, such as Sotyktu (approved for psoriasis), Xeljanz, and Olumiant.” Other substitutes may include tumor necrosis factor (TNF) inhibitors like Humira, Enbrel, and Remicade—biologic medications prescribed for the same range of diseases. Unfortunately, these don’t solve the weight gain problem since they can also cause it.

NSAIDs like naproxen and ibuprofen can help treat the symptoms of arthritis and other inflammatory diseases. They’re less expensive and available over the counter, making them an attractive option. But, while they can help with pain and inflammation, they won’t slow down the disease in the way DMARDs like azathioprine can.

Corticosteroids like prednisone are another popular treatment option, both on their own and alongside other drugs. However, they’re typically used for fast, temporary relief, and they may also cause weight gain.