Rinvoq And Velsipity: A Comprehensive Guide To Treatment Options For Seniors

Growing older often means dealing with health challenges, especially for seniors managing chronic conditions like rheumatoid arthritis, ulcerative colitis, or psoriatic arthritis. If you’re over 65 and exploring treatment options, you may have heard about Rinvoq (upadacitinib) and Velsipity (etrasimod)—two newer medications that can help. These oral drugs are making waves for their effectiveness, but they come with unique considerations for older adults. In this blog, I’ll break down what Rinvoq and Velsipity are, how they work, their benefits, potential risks, and what seniors should keep in mind, all in a way that feels like a conversation with a trusted friend. Let’s dive in!

What Are Rinvoq and Velsipity?

Rinvoq (Upadacitinib)

Rinvoq is a Janus kinase (JAK) inhibitor, a class of drugs that modulates the immune system by blocking enzymes called Janus kinases, which contribute to inflammation. It’s a once-daily oral medication approved for multiple conditions, including:

Rheumatoid arthritis (RA): For adults with moderately to severely active RA who have not responded well to methotrexate or other treatments.
Psoriatic arthritis (PsA): For adults who have not responded to tumor necrosis factor (TNF) blockers.
Atopic dermatitis (eczema): For adults and adolescents aged 12 and older with moderate to severe cases.
Ulcerative colitis (UC) and Crohn’s disease: For adults with moderate to severe disease when TNF blockers are ineffective.
Ankylosing spondylitis, non-radiographic axial spondyloarthritis, giant cell arteritis, and polyarticular juvenile idiopathic arthritis (pJIA): For specific cases where other treatments have failed.

Rinvoq works by calming an overactive immune system, reducing inflammation, pain, and other symptoms associated with these conditions. It’s available as extended-release tablets (15 mg or 30 mg) or an oral solution (Rinvoq LQ) for certain pediatric patients.

Velsipity (Etrasimod)

Velsipity is a sphingosine 1-phosphate (S1P) receptor modulator, a newer class of oral medication approved in October 2023 for adults with moderately to severely active ulcerative colitis. Unlike Rinvoq, which broadly suppresses immune activity, Velsipity works by trapping immune cells (lymphocytes) in lymph nodes, preventing them from reaching the colon and causing inflammation. This targeted approach makes it an attractive option for UC management, particularly for patients seeking an oral alternative to injectable biologics like Humira or Entyvio.

Velsipity’s oral administration and once-daily dosing offer convenience, and early market data suggest it’s gaining traction among gastroenterologists for UC treatment due to its efficacy and ease of use.

Efficacy of Rinvoq and Velsipity

Rinvoq’s Clinical Success

Rinvoq has been extensively studied for over 11 years, with clinical trials involving thousands of patients across multiple conditions. Here are some key findings:

Rheumatoid Arthritis: In clinical trials, Rinvoq achieved a 20% improvement in RA symptoms (ACR20) in 43–48% of patients compared to 14–19% for placebo or methotrexate. Some patients reported symptom relief as early as one week, with significant improvements by 12 weeks. Long-term studies (up to 5 years) show sustained benefits, including reduced joint damage and fatigue.
Psoriatic Arthritis: Studies showed 57–71% of patients achieved symptom reduction after 12 weeks, outperforming placebo (24–36%) and even adalimumab (Humira) in some cases.
Ulcerative Colitis and Crohn’s Disease: In the U-ENDURE Phase 3 trial, 49% of Crohn’s disease patients achieved clinical remission at 12 weeks with a 45 mg induction dose, compared to 29% for placebo. For UC, 64% of patients on a 30 mg maintenance dose sustained remission over one year, with younger patients (under 65) showing slightly better outcomes.
Atopic Dermatitis: Rinvoq cleared or nearly cleared skin in 39–62% of patients, compared to 5–8% for placebo, with significant reductions in disease severity.

These results highlight Rinvoq’s versatility and effectiveness across a range of inflammatory conditions, making it a strong option for patients who haven’t responded to traditional treatments like TNF blockers.

Velsipity’s Emerging Role

Velsipity, being newer to the market, has primarily been studied for UC. In clinical trials, it demonstrated superior efficacy over placebo, with a notable advantage in achieving endoscopic response and clinical remission. A Spherix Global Insights report noted that Velsipity’s user base after three months of launch was comparable to Rinvoq’s at a similar stage, suggesting strong early adoption. Analysts predict Velsipity could surpass its competitor Zeposia (another S1P modulator) due to better trial outcomes and Pfizer’s established reputation in gastroenterology.

However, Velsipity’s data is less extensive than Rinvoq’s, and head-to-head trials comparing it directly with Rinvoq or biologics like Humira are lacking. A 2023 systematic review found Rinvoq to be the most effective for early symptomatic remission in UC among FDA-approved therapies, but Velsipity’s oral administration gives it an edge for patient convenience.

Considerations for Seniors

Seniors face unique challenges when considering treatments like Rinvoq and Velsipity due to age-related factors such as weakened immune systems, comorbidities, and polypharmacy (taking multiple medications). Here’s how these drugs apply to older adults:

Rinvoq for Seniors

Efficacy in Seniors: Clinical trials show Rinvoq works similarly across age groups, including those 65 and older, with no significant reduction in efficacy. The recommended starting dose for seniors is 15 mg daily, with adjustments to 30 mg only under careful medical supervision.
Safety Concerns: Rinvoq carries boxed warnings from the FDA for serious risks, particularly relevant for seniors:
- Serious Infections: Rinvoq’s immune-suppressing action increases infection risk (e.g., pneumonia, shingles, tuberculosis). Seniors, who are naturally more susceptible to infections, must be monitored closely. Doctors may delay treatment if an active infection is present.
- Cardiovascular Risks: Increased risk of heart attack, stroke, or death in patients 50+ with at least one cardiovascular risk factor (e.g., smoking history, hypertension). This is especially critical for seniors, who often have such risk factors.
- Cancer Risk: Higher rates of lymphoma and non-melanoma skin cancer have been observed, particularly in current or past smokers. Seniors with a cancer history should discuss alternative treatments.
- Blood Clots: Rinvoq may cause venous thromboembolism or pulmonary embolism, which can be life-threatening. Seniors with a history of clotting disorders need careful evaluation.
- Other Side Effects: Common side effects include fatigue, fever, nausea, and liver enzyme elevations. Seniors may be more prone to fatigue or liver issues, requiring regular blood tests.
Pregnancy and Breastfeeding: While less relevant for seniors, Rinvoq is contraindicated in pregnancy and breastfeeding due to potential fetal harm.
Drug Interactions: Rinvoq interacts with medications like azathioprine, cyclosporine, and certain cancer drugs, which seniors may take for other conditions. Always inform your doctor about all medications, including over-the-counter drugs and supplements.

Velsipity for Seniors

Efficacy in Seniors: Specific data on Velsipity’s efficacy in seniors is limited, as trials primarily focused on adults aged 18–65. However, its mechanism (S1P modulation) is not expected to differ significantly by age, and the standard 2 mg daily dose is likely appropriate for seniors with UC.
Safety Concerns: Velsipity’s side effect profile is less severe than Rinvoq’s in some respects, but seniors still need caution:
- Infections: Like Rinvoq, Velsipity increases infection risk by reducing circulating lymphocytes. Seniors should avoid live vaccines and be monitored for signs of infection.
- Cardiac Effects: Velsipity can cause transient bradycardia (slow heart rate) or heart block, particularly during the first dose. Seniors with heart conditions (e.g., arrhythmias) may require cardiac monitoring.
- Liver and Eye Issues: Elevated liver enzymes and macular edema are rare but possible. Regular liver function tests and eye exams are recommended for seniors.
- Hypertension: Velsipity may increase blood pressure, a concern for seniors with existing hypertension.
Advantages: Velsipity’s oral administration is a significant benefit for seniors who prefer avoiding injections or infusions. Its targeted mechanism may result in fewer systemic side effects compared to JAK inhibitors like Rinvoq.

Comparing Rinvoq and Velsipity for UC

For seniors with UC, both Rinvoq and Velsipity are viable options, but their profiles differ:

Efficacy: Rinvoq has a stronger track record for rapid remission in UC, with 64% of patients maintaining remission at one year (30 mg dose). Velsipity shows promise but lacks long-term data or head-to-head comparisons. A 2023 review ranked Rinvoq highest for early symptomatic remission among UC therapies.
Administration: Both are once-daily oral pills, making them convenient for seniors who may struggle with injectables.
Safety: Rinvoq’s boxed warnings (infections, cardiovascular events, cancer, blood clots) indicate a higher risk profile, particularly for seniors. Velsipity’s risks (bradycardia, infections) are significant but may be less broad-ranging.
Cost and Access: Rinvoq’s Complete Savings Card can reduce costs to as low as $0/month for eligible patients, but seniors on Medicare may face coverage challenges. Velsipity’s cost data is less clear, but newer drugs often have high out-of-pocket costs without assistance programs.

Recent Studies and Market Insights

Recent research provides context for choosing between these drugs:

Rinvoq Studies: The U-ENDURE trial (2022) confirmed Rinvoq’s efficacy in Crohn’s disease and UC, with 49% of Crohn’s patients achieving remission at 12 weeks and 64% of UC patients maintaining remission at one year. A 2023 systematic review in The American Journal of Gastroenterology highlighted Rinvoq’s superior early remission rates in UC compared to biologics like Humira and other JAK inhibitors.
Velsipity Market Trends: A 2024 GlobalData report noted Velsipity’s strong early performance in the UC market, with a 1.1% market share within three months of launch, potentially doubling in six months. Its efficacy over placebo was better than Zeposia’s, and its oral delivery is a key differentiator.

Practical Tips for Seniors

Consult Your Doctor: Discuss your full medical history, especially heart disease, cancer, or infections, before starting either drug. Seniors should have baseline tests (e.g., TB, hepatitis, liver function) and regular follow-ups.
Monitor Side Effects: Report symptoms like fever, fatigue, chest pain, or swelling immediately. For Velsipity, watch for vision changes or slow heart rate during initial dosing.
Lifestyle Adjustments: Limit sun exposure (especially with Rinvoq) and avoid live vaccines. Maintain a healthy diet and hydration to manage side effects like nausea or fatigue.
Financial Assistance: Explore savings programs like Rinvoq Complete or Pfizer’s assistance for Velsipity. Check with Medicare or your insurer for coverage details.
Shared Decision-Making: Work with your doctor to weigh the benefits (e.g., rapid symptom relief) against risks, considering your overall health and treatment goals.

Conclusion

Rinvoq and Velsipity represent significant advancements in treating inflammatory conditions, offering seniors effective, oral options for managing RA, PsA, UC, and more. Rinvoq’s broad indications and robust clinical data make it a versatile choice, but its serious risks require careful monitoring, especially in seniors. Velsipity, while newer and focused on UC, offers a targeted approach with potentially fewer systemic risks, though long-term data is still emerging. By understanding these drugs’ benefits, risks, and suitability for older adults, seniors can make informed decisions with their healthcare providers to improve their quality of life while managing chronic conditions effectively.

For more information, visit Rinvoq’s official site or consult your doctor about Velsipity’s availability and suitability. Always prioritize personalized medical advice to ensure the best treatment plan for your needs.