Impact of upadacitinib on lipid profiles in Korean patients: a retrospective analysis

Abstract Background Atopic dermatitis (AD) and rheumatoid arthritis (RA) are chronic inflammatory disorders often treated with Janus kinase inhibitors, including upadacitinib. However, upadacitinib’s longitudinal effects on lipid levels in Asian patients remain poorly characterized. Methods This retrospective study included adult Korean patients with AD or RA receiving upadacitinib 15 mg daily for ≥ 12 weeks between 2020 and 2023. Serum TC, LDL, HDL, non-HDL cholesterol, and TG were assessed at baseline and during the first 24 weeks of treatment. Clinically relevant lipid threshold attainment, initiation or intensification of lipid-lowering therapy, and discontinuation of upadacitinib were also ascertained. Multivariable logistic regression was used to identify factors associated with ≥ 10% increases in TC and HDL at week 12. Results Of 216 patients (62 with AD and 154 with RA), TC (+ 26.4 mg/dL) and HDL (+ 9.2 mg/dL) increased significantly at week 4 and remained elevated through week 24. LDL increased significantly at week 4 but not thereafter, whereas non-HDL cholesterol increased significantly at week 4 but not at weeks 12 or 24. TG showed no consistent trend. Among patients whose baseline values were below the relevant thresholds, 71 of 205 (34.6%) newly attained TC ≥ 240 mg/dL and 11 of 110 (10.0%) newly attained LDL ≥ 160 mg/dL. Of the 193 patients not receiving lipid-lowering therapy at baseline, 28 (14.5%) initiated such therapy. No patient discontinued upadacitinib because of dyslipidemia. Conclusions In Korean patients with AD and RA, upadacitinib was associated with early and sustained increases in TC and HDL cholesterol and a transient increase in LDL cholesterol. The observed lipid changes prompted initiation of lipid-lowering therapy in a minority of patients but did not lead to discontinuation of upadacitinib. These findings support baseline lipid assessment and early follow-up, with subsequent management guided by overall cardiovascular risk and standard dyslipidemia guidelines.