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

INTRODUCTION: Regulatory safety warnings for Janus kinase inhibitors, based on increased cardiovascular events in the rheumatoid arthritis populations, have raised concern regarding their use in inflammatory bowel disease (IBD) patients with cardiovascular risk factors. METHODS: Patients 50 years and older with IBD initiating upadacitinib were studied. Lipids, atherosclerotic cardiovascular disease risk scores, and adverse events were longitudinally assessed. RESULTS: Low-density lipoprotein increased early but stabilized, whereas high-density lipoprotein increased, with no change in low-density lipoprotein:high-density lipoprotein ratio. Atherosclerotic cardiovascular disease 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.