Impact of Upadacitinib on Cardiovascular Events and Lipid Values in Older Inflammatory Bowel Disease Patients with Baseline Cardiovascular Risk

BACKGROUND: Regulatory safety warnings for Janus kinase inhibitors, based on increased cardiovascular (CV) events in the rheumatoid arthritis populations, have raised concern regarding their use in inflammatory bowel disease (IBD) patients with CV risk factors. METHODS: Patients ≥50 years with IBD initiating upadacitinib were studied. Lipids, atherosclerotic cardiovascular disease (ASCVD) risk scores, and adverse events were longitudinally assessed. RESULTS: LDL increased early but stabilized, while HDL increased, with no change in LDL:HDL ratio. ASCVD risk increased modestly (+1.2%). No major adverse cardiovascular events occurred. Two venous thromboembolism events occurred during active disease. DISCUSSION: In older patients with IBD and baseline cardiovascular risk, upadacitinib was not associated with cardiovascular events over 188 patient-years, supporting appropriate clinical use with risk monitoring.