NICE is the organisation that decides whether treatments should be available on the NHS in England. Wales and Northern Ireland usually follow NICE decisions too. The SMC is the organisation that decides for Scotland.

What is upadacitinib?

Upadacitinib is a type of drug called a JAK inhibitor. JAKs are proteins that are involved in activating your immune response. This can cause the gut inflammation in Crohn’s and Colitis. Upadacitinib blocks the effects of JAKs, which reduces inflammation.

The brand name for upadacitinib is Rinvoq.

Who can have upadacitinib?

NICE and the SMC have decided that upadacitinib should be available on the NHS for adults with moderately or severely active Ulcerative Colitis who:

• Did not respond well enough to standard treatments or biologic medicines
• Have stopped responding to standard treatments or biologic medicines
• Cannot have standard treatments or biologic medicines because of bad side effects

Standard treatments include aminosalicylates, oral steroids or immunomodulators (for example, azathioprine, mercaptopurine or methotrexate).

How do you have it?

You have upadacitinib as tablets that you take once a day.

How effective is it?

A large clinical trial looked at how well upadacitinib works in adults with moderately or severely active Ulcerative Colitis. The trial compared upadacitinib to dummy treatment (placebo). The trial found:

• After 8 weeks of treatment, 30 in every 100 people who had upadacitinib were in remission. Only 4 in every 100 people who had placebo were in remission.
• In this trial, people who responded to 8 weeks of upadacitinib either carried on taking it or switched to placebo. After 52 more weeks of treatment, 47 in every 100 people who carried on taking upadacitinib were in remission. This compared to 12 in every 100 people who switched to placebo.
• The rate of serious side effects was lower in people taking upadacitinib than in people taking placebo.

When will it be available?

The SMC approved upadacitinib for people with Ulcerative Colitis on 10 October 2022. When the SMC recommends a treatment option, they expect NHS boards in Scotland to make it available. But they do not state a time limit.

NICE approved upadacitinib for people with Ulcerative Colitis on 4 January 2023. Medicines approved by NICE should be available within 90 days of the final decision.

NICE is also assessing upadacitinib for people with Crohn’s. We expect them to make a decision on this by June 2023.

How do I get it?

Upadacitinib is not suitable for everyone with Ulcerative Colitis. If you think upadacitinib might be suitable for you, talk to your IBD team. Together, you can talk about your treatment options and decide what treatment is right for you.