Upadacitinib

Identification

Summary

Upadacitinib is an oral Janus kinase (JAK)1-selective inhibitor used in the treatment of moderate to severe rheumatoid arthritis, active psoriatic arthritis, ankylosing spondylitis, and severe atopic dermatitis, including in patients who did not respond well to other therapies.

Brand Names

Rinvoq

Generic Name

Upadacitinib

DrugBank Accession Number

DB15091

Background

Upadacitinib is an oral Janus kinase (JAK)1-selective inhibitor and a disease-modifying antirheumatic drug (DMARD) used in the treatment of rheumatoid arthritis to slow down disease progression. Rheumatoid arthritis is a chronic autoimmune inflammatory disease affecting the peripheral joints. It is characterized by synovial inflammation and hyperplasia, autoantibody production, cartilage damage and bone destruction, leading to co-morbidities.⁴ Despite a variety of therapeutic agents available for treatment, up to 40% of the patients do not respond to current therapies, including biological therapies.⁶ The etiology of the disease is mostly unknown; however, the role of JAK as a driver of immune-mediated conditions was discovered, leading to the use of JAK as therapeutic targets for rheumatoid arthritis.⁵ To reduce dose-related toxicity (as seen with some pan-JAK inhibitors) without significantly affecting efficacy, more selective JAK1 inhibitors, upadacitinib and filgotinib, were developed.⁴

The FDA approved upadacitinib in August 2019 and it is used for the treatment of active rheumatoid arthritis, psoriatic arthritis, atopic dermatitis, ulcerative colitis, and ankylosing spondylitis.⁹ In December 2019, it was additionally approved by the European Commission and Health Canada.^10,15 Upadacitinib is marketed under the brand name RINVOQ for oral administration.⁹

Type

Small Molecule

Groups

Approved, Investigational

Structure

3D

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MOLSDF3D-SDFPDBSMILESInChI

Similar Structures

Structure for Upadacitinib (DB15091)

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Weight

Average: 380.375
Monoisotopic: 380.157243745

Chemical Formula

C₁₇H₁₉F₃N₆O

Synonyms

• Upadacitinib

External IDs

• ABT 494
• ABT-494

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Pharmacology

Indication

Upadacitinib is indicated for the treatment of moderately to severely active rheumatoid arthritis or active psoriatic arthritis in adult patients who have had an inadequate response or intolerance to one or more disease-modifying anti-rheumatic drugs (DMARDs), such as TNF blockers.^9,14 In Europe, upadacitinib may be used as monotherapy or in combination with methotrexate for rheumatoid or psoriatic arthritis.¹⁴

Upadacitinib is indicated for use in patients 12 years of age and older with refractory, moderate-to-severe atopic dermatitis whose disease is inadequately controlled with other systemic therapies or when other therapies are inadvisable.^9,14

Upadacitinib is indicated for the treatment of active ankylosing spondylitis or radiographic axial spondyloarthritis in adult patients who have an inadequate response to conventional therapy.^9,14 It is also indicated to treat non-radiographic axial spondyloarthritis with objective signs of inflammation in adults who have had an inadequate response or intolerance to TNF blocker therapy.⁹

Upadacitinib is also indicated to treat moderately to severely active ulcerative colitis in adults who have had an inadequate response or intolerance to either conventional therapy or a biologic agent,¹⁴ such as to one or more TNF blockers.⁹

Upadacitinib is indicated to treat moderately to severely active Crohn’s disease in adults who have had an inadequate response or intolerance to one or more TNF blockers.^17,14

Combining upadacitinib with other JAK inhibitors, biologic DMARDs, or other potent immunosuppressive agents is not recommended.⁹

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Associated Conditions

Indication Type	Indication	Combined Product Details	Approval Level	Age Group	Patient Characteristics	Dose Form
Management of	Ankylosing spondylitis (as)		••••••••••••	•••••	•••••••••• •••••••• •• •••••••••••• •••••••	••••••• •••••••• •••••••
Used in combination to manage	Ankylosing spondylitis (as)		••••••••••••	•••••	•••••••••• •••••••• •• ••••••••••• •• ••••••	••••••• •••••••• •••••••
Management of	Moderately to severely active crohn's disease		••••••••••••	•••••	••••••• •• ••••••••• •••••••	••••••• •••••••• •••••••
Used in combination to manage	Moderately to severely active rheumatoid arthritis	Regimen in combination with: Methotrexate (DB00563)	••••••••••••	•••••	•••••••••• •••••••• •• ••••••••••• •• ••••••	••••••• •••••••• •••••••
Used in combination to manage	Moderately to severely active rheumatoid arthritis		••••••••••••	•••••		••••••• •••••••• •••••••

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Pharmacodynamics

Upadacitinib is a DMARD that works by inhibiting the Janus Kinases (JAKs), which are essential downstream cell signalling mediators of pro-inflammatory cytokines. It is believed that these pro-inflammatory cytokines play a role in many autoimmune inflammatory conditions, such as rheumatoid arthritis.⁶ In clinical trials, upadacitinib decreased the activity of pro-inflammatory interleukins, transiently increased the levels of lymphocytes, and insignificantly decreased the levels of immunoglobulins from the baseline.⁹

Mechanism of action

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease that involves the interplay of several mediators, including the immune cells (mainly T- and B-lymphocytes) and pro-inflammatory cytokines, such as the tumour necrosis factor (TNF), transforming growth factor (TGF), and interleukin 6 (IL-6).⁴ The Janus Kinase (JAK) family plays an essential role in the normal physiological functions (such as erythropoiesis), but also the signalling of pro-inflammatory cytokines that are implicated in many immune-mediated diseases.⁵ The JAK family consists of four isoforms (JAK1, JAK2, JAK3, and Tyrosine Kinase 2) that each interacts with different cytokine receptors and uniquely associates with the intracellular domains of Type I/II cytokine receptors.⁵ JAK1 is primarily involved in the signalling transduction pathways of IL-6, IFN and the common γ -chain cytokines, including IL-2 and IL-15.⁸ IL-6 has been closely studied in particular, as it is a major cytokine involved in B- and T-cell differentiation and the acute phase response in inflammation.⁷

Upon interaction of cytokines with their cytokine receptors, the JAKs mediate the JAK-STAT signal transduction pathway in response to receptor activation. JAKs are tyrosine kinases that cause phosphorylation of several proteins, including cytokine receptors and JAKs themselves. Phosphorylation of JAKs promotes the phosphorylation and activation of the signalling molecules called STATs, leading to their nuclear translocation, binding to DNA promoters, and target gene transcription. JAK1-mediated signalling pathways ultimately promote pro-inflammatory events, such as increased proliferation and survival of immune cells, T cell differentiation, and macrophage activation.⁵ Upadacitinib is a selective JAK1 inhibitor that has a negligible effect on JAK3, leading to an improved drug safety profile.⁴ Upadacitinib blocks the cellular processes that contribute to the inflammatory conditions in rheumatoid arthritis. In human leukocytes cellular assays, upadacitinib inhibited JAK1/3-induced phosphorylation of STAT3/5 mediated by IL-6/7.⁹

Target	Actions	Organism
ATyrosine-protein kinase JAK1	inhibitor	Humans

Absorption

Upadacitinib displays a dose-proportional pharmacokinetic profile over the therapeutic dose range. Following oral administration, the median time to reach Cmax (Tmax) ranges from 2 to 4 hours. The steady-state plasma concentrations of upadacitinib are reached within 4 days following multiple once-daily administrations, with minimal accumulation.⁹ Food intake has no clinically relevant effect on the AUC, Cmax, and Cmin of upadacitinib from the extended-release formulation.³

Volume of distribution

The volume of distribution of upadacitinib in a patient with rheumatoid arthritis and a body weight of 74 kg is estimated to be 224 L following oral administration of an extended-release formula.¹¹ In a pharmacokinetic study consisting of healthy volunteers receiving the extended-release formulation, the steady-state volume of distribution was 294 L.¹ Upadacitinib partitions similarly between plasma and blood cellular components with a blood to plasma ratio of 1.0.⁹

Protein binding

Upadacitinib is 52% bound to human plasma proteins.⁹

Metabolism

Upadacitinib predominantly undergoes CYP3A4-mediated metabolism;⁹ however, upadacitinib is a nonsensitive substrate of CYP3A4.³ It is also metabolized by CYP2D6 to a lesser extent.⁹ In a human radio-labelled study, about 79% of the total plasma radioactivity accounted for the parent drug, and about 13% of the total plasma radioactivity accounted for the main metabolite produced from mono-oxidation, followed by glucuronidation.⁹ There are no known active metabolites of upadacitinib.¹¹

Route of elimination

Following administration of a single radio-labelled dose from the immediate-release formulation, approximately 53% of the total dose was excreted in the feces where 38% of the excreted dose was an unchanged parent drug. About 43% of the total dose was excreted in the urine, where 24% of that dose was in the unchanged parent drug form.¹¹ Approximately 34% of the total dose of upadacitinib dose was excreted as metabolites.⁹

Half-life

The mean terminal elimination half-life of upadacitinib ranged from 8 to 14 hours following administration of the extended-release formulation.^9,11 In clinical trials, approximately 90% of upadacitinib in the systemic circulation was eliminated within 24 hours of dosing.⁹

Clearance

The apparent oral clearance of upadacitinib in healthy volunteers receiving the extended-release formulation was 53.7 L/h.¹

Adverse Effects

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Toxicity

There is limited clinical information on the overdose from upacitinib: in clinical trials, once-daily administration of 60 mg in extended-release formulations were well tolerated. In case of an overdose, it is recommended that the patient is monitored for signs and symptoms of adverse reactions and treated with appropriate symptomatic treatment.⁹

The oral LD₅₀ in rats is 14500 mg/kg.¹²

Pathways

Not Available

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Interactions

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This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.

• Approved
• Vet approved
• Nutraceutical
• Illicit
• Withdrawn
• Investigational
• Experimental
• All Drugs

Drug	Interaction
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Abametapir	The serum concentration of Upadacitinib can be increased when it is combined with Abametapir.
Abatacept	The risk or severity of adverse effects can be increased when Abatacept is combined with Upadacitinib.
Adalimumab	The risk or severity of adverse effects can be increased when Adalimumab is combined with Upadacitinib.
Adenovirus type 7 vaccine live	The therapeutic efficacy of Adenovirus type 7 vaccine live can be decreased when used in combination with Upadacitinib.
Aldesleukin	The risk or severity of adverse effects can be increased when Aldesleukin is combined with Upadacitinib.

Food Interactions

• Avoid grapefruit products. Upadacitinib exposure is increased when a strong CYP3A4 inhibitor such as grapefruit is used, which may increase the risk for drug-related adverse events.
• Avoid St. John's Wort. This herb induces CYP3A metabolism and may reduce serum levels of upadacitinib.
• Take with or without food. Food does not significantly affect drug concentrations.

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Product Ingredients

Ingredient	UNII	CAS	InChI Key
Upadacitinib hemihydrate	NEW4DV02U5	Not Available	GJMQTRCDSIQEFK-SCDRJROZSA-N
Upadacitinib tartrate	7KCW9IQM02	1607431-21-9	LATZVDXOTDYECD-UFTFXDLESA-N

Brand Name Prescription Products

Name	Dosage	Strength	Route	Labeller	Marketing Start	Marketing End	Region	Image
Rinvoq	Tablet, extended release	30 mg/1	Oral	AbbVie Inc.	2019-08-16	Not applicable
Rinvoq	Tablet, extended release	15 mg/1	Oral	AbbVie Inc.	2019-08-16	Not applicable
Rinvoq	Tablet, extended release	15 mg	Oral	Abb Vie Deutschland Gmb H & Co. Kg	2021-02-10	Not applicable
Rinvoq	Tablet, extended release	45 mg	Oral	Abb Vie Deutschland Gmb H & Co. Kg	2023-02-08	Not applicable
Rinvoq	Tablet, extended release	45 mg	Oral	Abbvie	2023-09-07	Not applicable

Categories

ATC Codes

L04AA44 — Upadacitinib

• L04AA — Selective immunosuppressants
• L04A — IMMUNOSUPPRESSANTS
• L04 — IMMUNOSUPPRESSANTS
• L — ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS

Drug Categories

• Antineoplastic and Immunomodulating Agents
• Antirheumatic Agents
• BCRP/ABCG2 Inhibitors
• BCRP/ABCG2 Substrates
• Cytochrome P-450 CYP2D6 Substrates
• Cytochrome P-450 CYP3A Substrates
• Cytochrome P-450 CYP3A4 Substrates
• Cytochrome P-450 Substrates
• Disease-modifying Antirheumatic Agents
• Enzyme Inhibitors
• Heterocyclic Compounds, Fused-Ring
• Immunosuppressive Agents
• Janus Kinase Inhibitor
• Janus Kinase Inhibitors
• OATP1B1/SLCO1B1 Inhibitors
• P-glycoprotein inhibitors
• P-glycoprotein substrates
• Protein Kinase Inhibitors
• Selective Immunosuppressants

Classification

Not classified

Affected organisms

• Humans and other mammals

Chemical Identifiers

UNII

4RA0KN46E0

CAS number

1310726-60-3

InChI Key

WYQFJHHDOKWSHR-MNOVXSKESA-N

InChI

InChI=1S/C17H19F3N6O/c1-2-10-7-25(16(27)24-9-17(18,19)20)8-11(10)13-5-22-14-6-23-15-12(26(13)14)3-4-21-15/h3-6,10-11,21H,2,7-9H2,1H3,(H,24,27)/t10-,11+/m1/s1

IUPAC Name

(3S,4R)-3-ethyl-4-{1,5,7,10-tetraazatricyclo[7.3.0.0^{2,6}]dodeca-2(6),3,7,9,11-pentaen-12-yl}-N-(2,2,2-trifluoroethyl)pyrrolidine-1-carboxamide

SMILES

CC[C@@H]1CN(C[C@@H]1C1=CN=C2C=NC3=C(C=CN3)N12)C(=O)NCC(F)(F)F

References

General References

1. Klunder B, Mittapalli RK, Mohamed MF, Friedel A, Noertersheuser P, Othman AA: Population Pharmacokinetics of Upadacitinib Using the Immediate-Release and Extended-Release Formulations in Healthy Subjects and Subjects with Rheumatoid Arthritis: Analyses of Phase I-III Clinical Trials. Clin Pharmacokinet. 2019 Aug;58(8):1045-1058. doi: 10.1007/s40262-019-00739-3. [Article]
2. Parmentier JM, Voss J, Graff C, Schwartz A, Argiriadi M, Friedman M, Camp HS, Padley RJ, George JS, Hyland D, Rosebraugh M, Wishart N, Olson L, Long AJ: In vitro and in vivo characterization of the JAK1 selectivity of upadacitinib (ABT-494). BMC Rheumatol. 2018 Aug 28;2:23. doi: 10.1186/s41927-018-0031-x. eCollection 2018. [Article]
3. Mohamed MF, Zeng J, Marroum PJ, Song IH, Othman AA: Pharmacokinetics of Upadacitinib With the Clinical Regimens of the Extended-Release Formulation Utilized in Rheumatoid Arthritis Phase 3 Trials. Clin Pharmacol Drug Dev. 2019 Feb;8(2):208-216. doi: 10.1002/cpdd.462. Epub 2018 Apr 24. [Article]
4. Biggioggero M, Becciolini A, Crotti C, Agape E, Favalli EG: Upadacitinib and filgotinib: the role of JAK1 selective inhibition in the treatment of rheumatoid arthritis. Drugs Context. 2019 Oct 24;8:212595. doi: 10.7573/dic.212595. eCollection 2019. [Article]
5. Schwartz DM, Kanno Y, Villarino A, Ward M, Gadina M, O'Shea JJ: JAK inhibition as a therapeutic strategy for immune and inflammatory diseases. Nat Rev Drug Discov. 2017 Dec 28;17(1):78. doi: 10.1038/nrd.2017.267. [Article]
6. Rivellese F, Lobasso A, Barbieri L, Liccardo B, de Paulis A, Rossi FW: Novel Therapeutic Approaches in Rheumatoid Arthritis: Role of Janus Kinases Inhibitors. Curr Med Chem. 2019;26(16):2823-2843. doi: 10.2174/0929867325666180209145243. [Article]
7. Guschin D, Rogers N, Briscoe J, Witthuhn B, Watling D, Horn F, Pellegrini S, Yasukawa K, Heinrich P, Stark GR, et al.: A major role for the protein tyrosine kinase JAK1 in the JAK/STAT signal transduction pathway in response to interleukin-6. EMBO J. 1995 Apr 3;14(7):1421-9. [Article]
8. Choy EH: Clinical significance of Janus Kinase inhibitor selectivity. Rheumatology (Oxford). 2019 Jun 1;58(6):953-962. doi: 10.1093/rheumatology/key339. [Article]
9. FDA Approved Drug Products: RINVOQ (upadacitinib) extended-release tablets, for oral use [Link]
10. AbbVie Receives European Commission Approval of RINVOQ™ (upadacitinib) for the Treatment of Adults with Moderate to Severe Active Rheumatoid Arthritis [Link]
11. FDA: Upadacitinib Summary Review [Link]
12. EZSolution: Upadacitinib MSDS [Link]
13. FDA: Upadacitinib Clinical Pharmacology and Biopharmaceutics Review(s) [Link]
14. EMA Product Information: RINVOQ (upadacitinib) extended-release tablets [Link]
15. Health Canada Approved Drug Products: Rinvoq (upadacitinib) extended-release tablets for oral use (October 2023) [Link]
16. FDA Approved Drug Products: RINVOQ (upadacitinib) extended-release tablets, for oral use (April 2023) [Link]
17. FDA Approved Drug Products: RINVOQ (upadacitinib) extended-release tablets, for oral use (May 2023) [Link]

External Links

ChemSpider

44210449

BindingDB

50503287

RxNav

2196092

ChEMBL

CHEMBL3622821

Wikipedia

Upadacitinib

Clinical Trials

Clinical Trials Learn More" title="About Clinical Trials" id="clinical-trials-info" class="drug-info-popup" href="javascript:void(0);">

Phase	Status	Purpose	Conditions	Count
4	Active Not Recruiting	Treatment	Atopic Dermatitis	1
4	Not Yet Recruiting	Treatment	Rheumatoid Arthritis	1
4	Recruiting	Prevention	Coronavirus Disease 2019 (COVID‑19) / Psoriatic Arthritis / Rheumatoid Arthritis / Spondylarthritis	1
4	Recruiting	Treatment	Acute Ulcerative Colitis	1
3	Active Not Recruiting	Treatment	Atopic Dermatitis	4

Pharmacoeconomics

Manufacturers

Not Available

Packagers

Not Available

Dosage Forms

Form	Route	Strength
Tablet	Oral	15.400 mg
Tablet, extended release	Oral	15 mg
Tablet, extended release	Oral	15 mg/1
Tablet, extended release	Oral	30 mg/1
Tablet, extended release	Oral	30 mg
Tablet, extended release	Oral	45 mg/1
Tablet, extended release	Oral	45 mg
Tablet	Oral	15 mg
Tablet, film coated, extended release	Oral	15 mg

Prices

Not Available

Patents

Patent Number	Pediatric Extension	Approved	Expires (estimated)	Region
US8962629	No	2015-02-24	2031-01-15
USRE47221	No	2019-02-05	2030-12-01
US9951080	No	2018-04-24	2036-10-17
US9963459	No	2018-05-08	2036-10-17
US10519164	No	2019-12-31	2036-10-17
US10597400	No	2020-03-24	2036-10-17
US10981923	No	2021-04-20	2036-10-17
US10981924	No	2021-04-20	2036-10-17
US11198697	No	2021-12-14	2036-10-17
US11186584	No	2021-11-30	2036-10-17
US10550126	No	2020-02-04	2036-10-17
US10995095	No	2021-05-04	2036-10-17
US10730883	No	2020-08-04	2036-10-17
US10344036	No	2019-07-09	2036-10-17
US10202393	No	2019-02-12	2036-10-17
US11365198	No	2016-10-17	2036-10-17
US11512092	No	2016-10-17	2036-10-17
US11524964	No	2016-10-17	2036-10-17
US11535624	No	2016-10-17	2036-10-17
US11535625	No	2016-10-17	2036-10-17
US11535626	No	2016-10-17	2036-10-17
US11607411	No	2018-03-09	2038-03-09
US11661425	No	2016-10-17	2036-10-17
US11564922	No	2018-03-09	2038-03-09
US11680069	No	2016-10-17	2036-10-17
US11718627	No	2016-10-17	2036-10-17
US11773106	No	2016-10-17	2036-10-17
US11767326	No	2016-10-17	2036-10-17
US11773105	No	2016-10-17	2036-10-17
US11795175	No	2016-10-17	2036-10-17
US11780848	No	2016-10-17	2036-10-17
US11787815	No	2016-10-17	2036-10-17
US11780847	No	2016-10-17	2036-10-17

Properties

State

Liquid

Experimental Properties

Property	Value	Source
melting point (°C)	16-19	MSDS
boiling point (°C)	189	MSDS

Predicted Properties

Property	Value	Source
Water Solubility	0.0707 mg/mL	ALOGPS
logP	2.57	ALOGPS
logP	0.85	Chemaxon
logS	-3.7	ALOGPS
pKa (Strongest Acidic)	13.99	Chemaxon
pKa (Strongest Basic)	4.11	Chemaxon
Physiological Charge	0	Chemaxon
Hydrogen Acceptor Count	3	Chemaxon
Hydrogen Donor Count	2	Chemaxon
Polar Surface Area	78.32 Å2	Chemaxon
Rotatable Bond Count	4	Chemaxon
Refractivity	93.03 m3·mol-1	Chemaxon
Polarizability	36.09 Å3	Chemaxon
Number of Rings	4	Chemaxon
Bioavailability	1	Chemaxon
Rule of Five	Yes	Chemaxon
Ghose Filter	Yes	Chemaxon
Veber's Rule	No	Chemaxon
MDDR-like Rule	No	Chemaxon

Predicted ADMET Features

Not Available

Spectra

Mass Spec (NIST)

Not Available

Spectra

Spectrum	Spectrum Type	Splash Key
Predicted MS/MS Spectrum - 10V, Positive (Annotated)	Predicted LC-MS/MS	splash10-001i-0009000000-26f010bbf61856f19049
Predicted MS/MS Spectrum - 10V, Negative (Annotated)	Predicted LC-MS/MS	splash10-056r-0059000000-e385e1406b634e6e600e
Predicted MS/MS Spectrum - 20V, Negative (Annotated)	Predicted LC-MS/MS	splash10-0udi-0190000000-cc2338f5d743f26d5c59
Predicted MS/MS Spectrum - 20V, Positive (Annotated)	Predicted LC-MS/MS	splash10-053r-1069000000-f8251949a60e4219c77e
Predicted MS/MS Spectrum - 40V, Negative (Annotated)	Predicted LC-MS/MS	splash10-0pbi-1390000000-a7a6ddaac25c9d3e6590
Predicted MS/MS Spectrum - 40V, Positive (Annotated)	Predicted LC-MS/MS	splash10-0a4i-0490000000-0dd94db82b2cab4b42a0
Predicted 1H NMR Spectrum	1D NMR	Not Applicable
Predicted 13C NMR Spectrum	1D NMR	Not Applicable

Chromatographic Properties

Collision Cross Sections (CCS)

Not Available

Targets

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Details1. Tyrosine-protein kinase JAK1

Kind

Protein

Organism

Humans

Pharmacological action

Yes

Actions

Inhibitor

General Function

Ubiquitin protein ligase binding

Specific Function

Tyrosine kinase of the non-receptor type, involved in the IFN-alpha/beta/gamma signal pathway. Kinase partner for the interleukin (IL)-2 receptor.

Gene Name

JAK1

Uniprot ID

P23458

Uniprot Name

Tyrosine-protein kinase JAK1

Molecular Weight

133275.995 Da

References

1. Biggioggero M, Becciolini A, Crotti C, Agape E, Favalli EG: Upadacitinib and filgotinib: the role of JAK1 selective inhibition in the treatment of rheumatoid arthritis. Drugs Context. 2019 Oct 24;8:212595. doi: 10.7573/dic.212595. eCollection 2019. [Article]
2. Parmentier JM, Voss J, Graff C, Schwartz A, Argiriadi M, Friedman M, Camp HS, Padley RJ, George JS, Hyland D, Rosebraugh M, Wishart N, Olson L, Long AJ: In vitro and in vivo characterization of the JAK1 selectivity of upadacitinib (ABT-494). BMC Rheumatol. 2018 Aug 28;2:23. doi: 10.1186/s41927-018-0031-x. eCollection 2018. [Article]

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Drug created at May 20, 2019 14:49 / Updated at December 14, 2023 19:14