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A prescription pad and a pill bottle: Rinvoq for atopic dermatitis
Drug Info

Rinvoq for atopic dermatitis

Atopic dermatitis, also called eczema, is one of the conditions Rinvoq is approved to treat
Leandra Beabout
By | Jul. 8, 2024 Medically reviewed by Chad Shaffer, MD

Key takeaways

  • Atopic dermatitis, or eczema, is an inflammatory skin condition characterized by dry, itchy skin. 

  • Rinvoq is an oral prescription medication containing the active ingredient upadacitinib. It can be used to treat symptoms of eczema, rheumatoid arthritis, psoriatic arthritis, ulcerative colitis, Crohn’s disease, ankylosing spondylitis, and non-radiographic axial spondyloarthritis.

  • Talk to your healthcare provider for medical advice and information about Rinvoq or other atopic dermatitis treatments.

In this article:

Atopic dermatitis, also known as eczema, is a skin condition that causes dry, itchy, irritated skin. According to the National Institutes of Health, eczema affects 15%–30% of children and 2%–10% of adults at some point in their life. 

There is no cure for eczema, but symptoms can be managed with moisturizers, topical corticosteroids, systemic treatments, or a combination of them all. People with severe eczema may be prescribed an oral medication such as Rinvoq for atopic dermatitis. Rinvoq is a brand-name prescription drug manufactured by AbbVie that contains the active ingredient upadacitinib. It belongs to a class of medications called Janus kinase (JAK) inhibitors, or disease-modifying antirheumatics. 

“Rinvoq works by lowering your immune system activity,” said Joanne Nguyen, Pharm.D., a clinical pharmacy practitioner in Georgia. By suppressing a specific pathway in the immune system, Rinvoq reduces inflammation and relieves symptoms associated with inflammatory conditions.

The Food & Drug Administration (FDA) has approved Rinvoq to treat:

This article will unpack the benefits, dosage, side effects, and risks of Rinvoq for atopic dermatitis.

How does Rinvoq work for atopic dermatitis?

Atopic dermatitis is not classified as an autoimmune disease. However, the National Eczema Association is clear that an immune system overreaction is involved in the development of eczema symptoms. 

“There are times when inflammation is an important process for the body to trigger the immune system, and there are some people whose cells create too much inflammation, which leads to diseases like atopic dermatitis,” explained Blair Gingerich, Pharm.D., an ambulatory care pharmacist in northern Indiana. “There are multiple pathways for a cell to create inflammation. Rinvoq stops one of these pathways, which calms an overactive inflammatory response.”

By blocking that one specific pathway that causes inflammation, Rinvoq calms eczema flare-ups, improving symptoms such as rash, redness, and itching. 

Benefits of Rinvoq for atopic dermatitis

Rinvoq does not cure atopic dermatitis. However, clinical study endpoints—measurable outcomes—have demonstrated the benefits and safety of upadacitinib, the active ingredient in Rinvoq.

AbbVie, the drug’s manufacturer, funded two 16-week placebo-controlled clinical trials to measure the efficacy of Rinvoq for adolescents and adults with moderate-to-severe atopic dermatitis. The studies, called Measure Up 1 and Measure Up 2, took place from 2018 to 2020.

Results of Measure Up 1: 

  • By week 2, 38% of patients taking 15 milligrams (mg) once daily had 75% skin clearance (a 75% reduction from baseline in lesion extent and severity, according to the Eczema Area and Severity Index, or EASI-75) versus 4% for placebo, an inactive pill.
  • By week 16, 70% of patients taking 15 mg once daily saw 75% skin clearance, while 16% of those taking placebo had this response.
  • By week 16, 52% of patients taking 15 mg once daily reported at least a 4-point improvement in itch on the 10-point Worst Pruritus Numerical Rating Scale (WP-NRS), compared to 12% taking placebo.

 Results of Measure Up 2:

  • By week 2, 33% of patients taking 15 mg once daily saw 75% skin clearance, while this was seen in only 4% of those taking placebo.
  • By week 16, 60% of patients taking 15 mg once daily saw 75% skin clearance versus 13% on placebo.
  • By week 16, 42% of patients taking 15 mg once daily reported at least a 4-point improvement in itch on the 10-point WP-NRS, compared to 9% with placebo.

Studies of Rinvoq use for up to 140 weeks show that the benefits and safety profile are consistent for long-term use. 

In the end, individual benefits from Rinvoq for atopic dermatitis may vary. Before prescribing Rinvoq, a healthcare professional must consider several factors, including a patient’s medical condition(s), medical history, symptom severity, and other medications they’re taking.

Rinvoq dosage for atopic dermatitis

Rinvoq is available in 15-milligram (mg), 30-mg, or 45-mg extended-release tablets. All doses are once-daily pills.

A person’s prescribed Rinvoq dose depends on their age and the condition being treated. For atopic dermatitis, Rinvoq’s recommended starting dose  is 15 mg daily. 

Patients between the ages of 12 and 65 who weigh at least 88 pounds may also be prescribed a 30-mg dose if their symptoms do not improve on the starting dosage.

People starting Rinvoq for the first time may wonder how long it takes to work. That depends on the person, but results from Measure Up 1 and Measure Up 2 suggest that 16% of patients notice less itch within two days of their first Rinvoq dose. 

Rinvoq side effects, warnings, and interactions with other atopic dermatitis drugs

Rinvoq is not right for everyone. Although it is an effective treatment for atopic dermatitis, it is also an immunosuppressant. It can cause unpleasant side effects and raises your risk of several serious health problems, including infection. 

According to the drug’s label, the most common Rinvoq side effects in people with atopic dermatitis include:

  • Upper respiratory tract infections
  • Acne
  • Herpes simplex
  • Headache

Rinvoq may also increase a person’s risk of herpes zoster (shingles) and cold sores.

Those are the side effects, but what about the risks?

First, it’s important to know that any new medication can cause an allergic reaction. People who have symptoms of an allergic reaction to Rinvoq should seek urgent medical attention. Symptoms of anaphylaxis, a serious allergic reaction, include hives, trouble swallowing, difficulty breathing, or facial swelling.

Secondly, Rinvoq’s impact on the immune system can increase the risk of serious medical conditions and diseases. “Rinvoq has boxed warnings for increased risk of cancer, serious infections, and heart problems, including heart attack and stroke,” Dr. Nguyen said. “Boxed warnings are the most serious warnings issued by the FDA for medications.” Prescribing information states that current or past smokers have a higher risk of developing lymphoma and lung cancer. People with a history of cancer, cardiovascular events, and kidney disease may be advised against Rinvoq because of these risk factors. 

Finally, Rinvoq patients should not mix this medication with any of the following:

  • Another JAK inhibitor
  • Any biologic disease-modifying antirheumatic drug (DMARD)
  • Strong immunosuppressants such as cyclosporine and azathioprine
  • Live vaccines

Several other medications can affect how the body processes upadacitinib, the active ingredient in Rinvoq. It’s essential to tell your healthcare provider about all other

medications, vitamins, and supplements you take to avoid dangerous interactions. Ask your dermatologist to discuss important safety information before starting Rinvoq.

Rinvoq vs. other treatments for atopic dermatitis

Rinvoq is FDA approved to treat moderate-to-severe eczema, but it is not the only drug for this condition.

“There are several other options for moderate to severe disease,” Dr. Gingerich said. “An example is Dupixent, which works by suppressing a different inflammatory pathway but has similar results. It is an injectable. 

RELATED: Rinvoq vs. Dupixent

Another example is a drug called methotrexate, which has been around for a long time and can be used off-label for atopic dermatitis. “It is oral like Rinvoq, but it’s not specific with the inflammatory pathway that it targets,”  Dr. Gingerich said. Adbry (tralokinumab-ldrm), an interleukin-13 (IL-13) inhibitor, is a third option for moderate to severe atopic dermatitis.

When comparing Rinvoq versus other treatments for atopic dermatitis, Dr. Nguyen emphasizes that Rinvoq has more significant side effects.

Will insurance cover Rinvoq for atopic dermatitis?

Yes, some—but not all—insurance plans cover Rinvoq for atopic dermatitis. Many companies, such as Cigna, require prior authorization. That means the insurance company requires information from the prescribing dermatologist before agreeing to pay for the prescription. 

People with commercial insurance should call their health insurance provider to ask about prescription drug coverage options and copay information. 

People with Medicare Part D should call 800-2RINVOQ to find out more about their state’s Rinvoq coverage options.  

How to save on Rinvoq

Rinvoq is a very expensive medication without insurance. Currently, the average cost of a 30-day supply of Rinvoq, regardless of dosage, is $8,300 for 30 tablets without insurance or coupons.

Fortunately, there are ways to save on Rinvoq:

  • Singlecare prescription discount card – Cash-paying patients can also save money on Rinvoq with a SingleCare prescription discount card that can be used for free drug coupons. With Singlecare coupons, the cost of a 30-day supply of Rinvoq can be lowered to about $5,900. 
  • Rinvoq copay card – The Rinvoq Complete Savings Card could bring your copay down to $0 per month if you meet eligibility requirements, including having commercial health insurance. 
  • Manufacturer’s patient assistance program  – A program called myAbbVie Assist can help patients who meet specific income criteria and are uninsured, underinsured, or unemployed get Rinvoq for free. 
  • Medicare Extra Help – People who need help paying for prescription drugs may apply for a low-income subsidy through the Medicare Extra Help program. Income limits apply.