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Impact of Upadacitinib on Cardiovascular Events and Lipid Values in Older Inflammatory Bowel Disease Patients With

Tenzin Choden1, Alex J Mathew1, Aaron Goffinet2

  • 1University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, Illinois, USA.

The American Journal of Gastroenterology
|June 9, 2026
PubMed

Insights

Upadacitinib use in older inflammatory bowel disease (IBD) patients with cardiovascular risk factors did not lead to major cardiovascular events. Careful monitoring supports its appropriate clinical use in this population.

Area of Science:

  • Gastroenterology
  • Cardiology
  • Pharmacology

Background:

  • Janus kinase (JAK) inhibitors carry cardiovascular (CV) safety warnings from rheumatoid arthritis studies.
  • Concerns exist about using JAK inhibitors in inflammatory bowel disease (IBD) patients with CV risk factors.

Purpose of the Study:

  • To assess the cardiovascular safety of upadacitinib in older IBD patients with pre-existing CV risk factors.

Main Methods:

  • Longitudinal assessment of lipids, atherosclerotic cardiovascular disease (ASCVD) risk scores, and adverse events.
  • Study included patients aged 50 years and older with IBD initiating upadacitinib.

Main Results:

  • Low-density lipoprotein (LDL) increased initially then stabilized; high-density lipoprotein (HDL) increased; LDL:HDL ratio remained unchanged.
  • A modest increase in ASCVD risk (+1.2%) was observed.
  • No major adverse cardiovascular events occurred; two venous thromboembolism events occurred during active disease.

Conclusions:

  • Upadacitinib was not associated with cardiovascular events in older IBD patients with baseline CV risk over 188 patient-years.
  • Findings support the appropriate clinical use of upadacitinib in this population, provided CV risk is monitored.
Abstract

Keywords:
ASCVD risk scoreCrohn's diseaseJAK inhibitorcardiovascular riskinflammatory bowel diseasemajor adverse cardiovascular eventsulcerative colitisupadacitinib

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