Rinvoq vs. Xeljanz: 7 Things to Know When Comparing These Psoriatic Arthritis Medications

Janus kinase (JAK) inhibitors are a class of medications that have been growing in popularity in recent years. Researchers keep discovering new types of JAK inhibitors, as well as new uses for those already FDA approved. Two well-known JAK inhibitors are Rinvoq (upadacitinib) and Xeljanz (tofacitinib).

Rinvoq and Xeljanz are both approved to treat psoriatic arthritis (PsA), as well as several other autoimmune disorders. At first glance, they seem quite similar. But they do have a few distinctions that set them apart.

Below, we’ll cover seven key facts to know when comparing Rinvoq and Xeljanz. That way, you and your healthcare provider can make an informed decision when picking the right one for you.

1. Rinvoq and Xeljanz have different FDA-approved uses

As mentioned above, both Rinvoq and Xeljanz are FDA approved to treat PsA in adults. But there are differences when it comes to their other uses.

Rinvoq is also approved to treat:

• Moderate to severe rheumatoid arthritis (RA) in adults

• Moderate to severe atopic dermatitis (a type of eczema) in adults and adolescents ages 12 years and older

• Moderate to severe ulcerative colitis (UC) in adults

• Moderate to severe Crohn’s disease in adults

• Ankylosing spondylitis (AS) in adults

• Non-radiographic axial spondyloarthritis in adults

Promotion disclosure

Xeljanz

Avg retail price

$5772.67(Save 16.07%)

GoodRx discount

$4845.07

See all discounts

How it works

Use GoodRx to find medications, pharmacies, and discounts.

GoodRx discounts can help you pay less for your prescription.

Bring your free coupon or savings card to the pharmacy.

In addition to PsA, Xeljanz is approved to treat:

• Moderate to severe RA in adults

• AS in adults

• Moderate to severe UC in adults

• Polyarticular course juvenile idiopathic arthritis in people ages 2 years and older

2. Rinvoq and Xeljanz work similarly in the body

Rinvoq and Xeljanz have similar mechanisms of action (how they work in the body). They work by blocking the activity of certain JAKs. JAKs are a group of enzymes (proteins) that help create pain and inflammation in the body. JAKs work together with another group of proteins called cytokines.

Cytokines are released by certain immune cells to provide pain and inflammation signals to other cells in your body. However, cytokines can cause unwanted inflammation in autoimmune disorders, like PsA. JAKs help carry out cytokine signals.

JAK inhibitors, like Rinvoq and Xeljanz, block JAKs from receiving cytokine signals. This mechanism of action helps lower the inflammation that causes PsA symptoms.

3. Rinvoq and Xeljanz have different dosage forms available

Rinvoq and Xeljanz are both taken by mouth. Rinvoq is available as 15 mg, 30 mg, and 45 mg extended-release (ER) tablets. The recommended dosage for PsA is 15 mg by mouth once daily with or without food. Rinvoq tablets must be swallowed whole. Don’t split, chew, or crush the tablets.

There are two versions of Xeljanz for PsA: immediate-release (IR) and ER tablets. An oral solution is also available, but it’s not FDA approved for PsA.

Your Xeljanz dosage depends on the form you’re taking. The Xeljanz IR dosage is typically 5 mg twice daily. The Xeljanz XR dosage is 11 mg once daily. Both forms can be taken with or without food.

Xeljanz XR tablets must be swallowed whole. You may notice what looks like a pill in your stool when taking Xeljanz XR. This is normal and expected. This is only the outer covering of the pill.

4. Rinvoq and Xeljanz are both effective treatments, but neither are considered first-choice options

Both Rinvoq and Xeljanz are effective treatment options for PsA in adults. It’s important to note that they haven’t been directly compared for the treatment of PsA in clinical trials. So we can’t say if one works better than the other. But when compared to placebo (a pill with no medication in it), both Rinvoq and Xeljanz provided significant symptom improvement.

Keep in mind that JAK inhibitors aren’t a first-choice treatment for PsA. Experts recommend trying a biologic medication, such as Humira (adalimumab), first. JAK inhibitors may be considered if biologics aren’t working, or you can’t tolerate them. This is because there’s more evidence supporting the effectiveness and safety of biologics to treat PsA compared to Rinvoq or Xeljanz.

5. Rinvoq and Xeljanz have distinct common side effects

For the most part, Rinvoq and Xeljanz have unique common side effects. But they can both raise your risk of infections. This is because, in order to lessen PsA symptoms, Rinvoq and Xeljanz have to suppress (weaken) the immune system. During clinical trials, upper respiratory infections, such as the common cold, were the type of infection most frequently reported.

Other common side effects of Rinvoq include:

• Headache

• Acne

• Nausea

• Fever

Common side effects of Xeljanz include:

• Diarrhea

• Headache

• Raised blood pressure

6. Rinvoq and Xeljanz have similar serious risks and warnings

Although rare, Rinvoq and Xeljanz can increase the risk of serious infections. Examples of these include:

• Tuberculosis (TB)

• Pneumonia

• Shingles

• Skin infections (such as cellulitis)

Your healthcare provider will monitor you closely for these infections. You’ll also be screened for TB before starting Rinvoq or Xeljanz.

Both Rinvoq and Xeljanz have warnings for other serious side effects as well:

• Higher risk of death

• Cancers, such as lung cancer

• Heart attacks and strokes

• Blood clots

In 2021, the FDA added these serious side effects to the boxed warning of all JAK inhibitors that are approved to treat autoimmune disorders. People taking Rinvoq or Xeljanz should discuss these risks with their healthcare providers before starting either medication.

7. Rinvoq and Xeljanz have similar drug interactions

Both Rinvoq and Xeljanz are broken down in your liver by a certain enzyme. This enzyme is also involved with the breakdown of many other medications. Because of this, there are several medications that interact with Rinvoq and Xeljanz.

Some notable Rinvoq and Xeljanz interactions include:

• Carbamazepine (Tegretol)

• Clarithromycin (Biaxin)

• Fluconazole (Diflucan)

• Phenytoin (Dilantin)

• Rifampin (Rifadin)

• St. John’s wort, an over-the-counter herbal product

• Biologics for autoimmune disorders, such as Humira

• Immunosuppressants, such as azathioprine (Imuran)

You should also limit the amount of grapefruit and grapefruit juice in your diet while taking Rinvoq or Xeljanz. And, keep in mind, the list above doesn’t include all interacting medications. Make sure to share your current medication list with your healthcare provider and pharmacist first before starting any new medications or supplements.

Vaccine interactions

People taking Rinvoq or Xeljanz shouldn’t receive live vaccines. This is because JAK inhibitors suppress the immune system. People with weakened immune systems are recommended to avoid live vaccines.

Examples of live vaccines include the following:

• Measles, mumps, rubella (MMR)

• Varicella (Varivax), the chickenpox vaccine

• Yellow fever vaccine (Yf-Vax)

• Live flu vaccine (FluMist), the nasal spray flu vaccine

The inactivated flu vaccine and COVID-19 vaccines aren’t live vaccines. They can be given to people taking Rinvoq or Xeljanz. Make sure to let your healthcare provider know all the medications you take before getting vaccinated.

So how do you choose between Rinvoq and Xeljanz?

Since Rinvoq and Xeljanz are very similar, the choice may come down to your insurance coverage. Insurance plans often have a preferred medication in a class. So it may be a good idea to contact your insurance provider ahead of time for details. You can also try looking up your insurance plan’s formulary. This can help you find out which JAK inhibitor is preferred and what your expected copay might be.

How to save on Rinvoq and Xeljanz

Rinvoq and Xeljanz are only available as brand-name medications. But GoodRx can help you navigate ways to save on your prescription.

• Save with a copay savings card. If you have commercial insurance and meet eligibility requirements, Rinvoq is as little as $5 per month if you use the manufacturer’s savings card. Xeljanz is as little as $0 per month if you use the manufacturer’s savings card.

• Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for Rinvoq or Xeljanz patient assistance programs, which offer the medication at no charge.

Why trust our experts?

Written by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Our editorial standards

Meet our experts