Clinical Report: Cardiovascular Safety and Myocardial Deformation Indicators Following Upadacitinib Treatment

Overview

This study assessed the cardiovascular safety and myocardial deformation indicators following upadacitinib initiation in patients with immune-mediated inflammatory conditions.

Background

The cardiovascular safety of Janus kinase (JAK) inhibitors is a significant concern due to class-wide warnings from regulatory agencies regarding major adverse cardiovascular events. Patients with immune-mediated inflammatory disorders have an elevated cardiovascular risk that is not fully explained by traditional factors. Understanding the cardiovascular implications of JAK inhibitors, particularly upadacitinib, is crucial for informed clinical decision-making.

Data Highlights

Key Findings

• Upadacitinib initiation did not lead to early structural or systolic myocardial impairment.
• Global longitudinal strain (GLS) showed a significant overall time effect with improvement at 1 month, sustained through 6 months.
• No significant changes were observed in left ventricular ejection fraction (LVEF), left ventricular mass index, or epicardial fat thickness.
• E/e′ increased modestly at 6 months without evidence of structural remodeling.

Clinical Implications

The results indicate that upadacitinib does not appear to cause early myocardial harm in patients with immune-mediated inflammatory conditions.

Conclusion

The initiation of upadacitinib was associated with no early myocardial harm and a favorable GLS trajectory.

Related Resources & Content

1. The New Gastroenterologist, 2025 -- Assessing the Risk-Benefit Ratio of Upadacitinib for Inflammatory Bowel Disease
2. JAMA Oncology, 2025 -- Upadacitinib for Immune Checkpoint Inhibitor–Related Dermatitis: A Nonrandomized Clinical Trial
3. Basic Research in Cardiology, 2025 -- Molecular Signatures of Cardiovascular Toxicity Linked to Immune Checkpoint Inhibitors
4. The ASCO Post, 2022 -- Incidence of Major Adverse Cardiac Events in Patients Receiving Immune Checkpoint Inhibitors
5. FDA, 2021 -- FDA requires warnings about increased risk of serious heart-related events, cancer, blood clots, and death for JAK inhibitors
6. Drug Safety, 2025 -- Major Adverse Cardiovascular Events Related to JAK Inhibitors: A Disproportionality Analysis Using the WHO Global Individual Case Safety Database
7. American Society of Echocardiography, 2025 -- Clinical Applications of Strain Echocardiography: A Clinical Consensus Statement
8. FDA requires warnings about increased risk of serious heart-related events, cancer, blood clots, and death for JAK inhibitors that treat certain chronic inflammatory conditions | FDA
9. Major Adverse Cardiovascular Events Related to JAK Inhibitors: A Disproportionality Analysis Using the WHO Global Individual Case Safety Database | Drug Safety | Springer Nature Link
10. Clinical Applications of Strain Echocardiography: A Clinical Consensus Statement From the American Society of Echocardiography Developed in Collaboration With the European Association of Cardiovascular Imaging of the European Society of Cardiology