How do Rinvoq and Dupixent compare?
Atopic dermatitis (eczema) is a challenging skin disease, and therapies have advanced with the development of targeted medications like Rinvoq (upadacitinib) and Dupixent (dupilumab). Both are considered advanced treatments but differ significantly in how they work, their approved uses, side effect profiles, and cost structures. Here’s what you need to know before discussing options with your healthcare provider.
FDA-Approved Uses
Rinvoq and Dupixent are both FDA approved for atopic dermatitis, and can be used for several other conditions too.
Rinvoq (upadacitinib)
- Rheumatoid arthritis
- Psoriatic arthritis
- Atopic dermatitis
- Ulcerative colitis
- Crohn’s disease
- Ankylosing spondylitis
- Non-radiographic axial spondyloarthritis
- Polyarticular juvenile idiopathic arthritis
- Giant cell arteritis
Dupixent (dupilumab)
- Atopic dermatitis
- Asthma
- Chronic rhinosinusitis with nasal polyps
- Eosinophilic esophagitis
- Prurigo nodularis
- Chronic obstructive pulmonary disease (COPD)
- Chronic spontaneous urticaria
- Bullous pemphigoid
Below is a table that compares FDA-approved uses between Rinvoq and Dupixent.
| Condition | Rinvoq (upadacitinib) | Dupixent (dupilumab) |
|---|---|---|
| Atopic dermatitis | Adults & teens (12+) | Adults & children (6 months+) |
| Asthma | No | Yes |
| Ulcerative colitis | Yes | No |
| Eosinophilic esophagitis | No | Yes |
| Rheumatoid arthritis | Yes | No |
| Psoriatic arthritis | Yes | No |
| Crohn’s disease | Yes | No |
| Polyarticular juvenile idiopathic arthritis | Yes | No |
| Prurigo nodularis | No | Yes |
| COPD | No | Yes |
| Giant cell arteritis | Yes | No |
| Bullous pemphigoid | No | Yes |
| Chronic spontaneous urticaria | No | Yes |
| Ankylosing spondylitis | Yes | No |
| Non-radiographic axial spondyloarthritis | Yes | No |
| Nasal polyps | No | Yes |
Both drugs have additional or evolving indications beyond this table. Refer to their FDA labels for the most current list of uses. Dupixent and Rinvoq are sometimes prescribed off-label (not FDA approved) for certain conditions. For example, Dupixent may be prescribed for alopecia areata.
How Rinvoq and Dupixent Work (Mechanism of Action)
Rinvoq and Dupixent work in different ways to reduce inflammation.
- Rinvoq: A Janus kinase (JAK) inhibitor, Rinvoq blocks specific pathways inside immune cells that signal for inflammation. Think of it like stopping an overactive “alarm system” from the inside.
- Dupixent: This medication blocks interleukin-4 (IL-4) and interleukin-13 (IL-13), two messengers on the “outside” leading to allergic inflammation. It's akin to stopping an overzealous messenger from delivering the signal that triggers allergic reactions.
Effectiveness for Eczema
The head-to-head LEVEL UP trial analyzed adults with moderate-to-severe eczema:
- Skin improvement: At 16 weeks, 40.8% of patients taking Rinvoq achieved nearly clear skin (EASI-90) versus 22.5% for Dupixent. Combining strong skin clearance and minimal itch, 19.9% of Rinvoq users hit this dual-target milestone compared to 8.9% on Dupixent.
- Itch relief: A higher proportion of Rinvoq-treated patients reported near-complete itch relief by week 16.
- Long-term data: The trial focused on 16 weeks; other studies suggest longer-term benefits/differences may require more research.
Rinvoq showed greater improvement in some outcomes at 16 weeks, but each drug's long-term efficacy and side-effect profile should be considered carefully.
Side Effects and Safety
When choosing between Rinvoq and Dupixent, understanding their side effect profiles and safety considerations is crucial. While both medications effectively target inflammatory pathways linked to atopic dermatitis and other conditions, they carry distinct risks and precautions. Awareness of common and serious side effects can help you and your healthcare provider make an informed decision that best fits your health needs and lifestyle.
| Rinvoq | Dupixent | |
|---|---|---|
| Common side effects | Nausea, acne, upper respiratory tract infections, headache | Eye problems, injection site reactions, upper respiratory infection, cold sores, back pain |
| Serious risks | Infections, blood clots, cancer, GI perforations, allergic reaction | Eosinophilia, allergic reaction |
| Boxed warning | Yes (serious infections, cancer, all-cause mortality, MACE, thrombosis) | No |
Rinvoq has a higher risk of infections because it suppresses immune signaling more broadly. Dupixent’s effect on the immune system is more targeted and typically avoids severe general immune suppression.
The side effects listed above do not include all possible side effects from taking Rinvoq or Dupixent. Refer to the FDA-approved labels or consult with your healthcare professional to review all reported side effects from these medications.
Related questions
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Dosing and Administration
Dosing and administration for Rinvoq and Dupixent differ in several key ways. Rinvoq is taken as a daily oral tablet, with flexible dosing depending on the specific condition being treated. In contrast, Dupixent is given as a subcutaneous injection every two or four weeks, with the dose determined by age and weight. Both medications can be self-administered, allowing for treatment at home, but the choice between a daily pill and periodic injections may influence patient preference and adherence.
| Rinvoq | Dupixent | |
|---|---|---|
| How it’s taken | Oral tablet (daily) | Injection (every 2 or 4 weeks) |
| Dose options | Flexible, based on condition | Fixed, based on age/weight |
| Self-administration | Yes | Yes |
Cost and Insurance Coverage
The cost and insurance coverage for Rinvoq and Dupixent can differ widely and may significantly impact treatment choices. Both medications are considered specialty therapies, often with high cash prices that vary depending on dosage, supply, and pharmacy.
Insurance coverage, patient assistance programs, and manufacturer discounts can help lower out-of-pocket expenses, but eligibility requirements and the need for prior authorization may affect access. Understanding these factors can help patients and caregivers better plan for the financial aspects of treatment.
- Rinvoq: List price is around $6,900 per month without insurance and using a free Drugs.com discount card. Manufacturer assistance, insurance coverage (sometimes with prior authorization), and copay cards can reduce costs.
- Dupixent: List price is around $4,000 per carton (usually a 4 week supply) without insurance and using a free Drugs.com discount card. Insurance coverage is common; copay cards and patient assistance programs are available.
Prices depend on pharmacy location, strength of the medication, days supply, insurance coverage, coupons, and other factors.
Which Is Right for You: Rinvoq or Dupixent?
Choosing between Rinvoq and Dupixent involves weighing factors like your specific medical history, other health conditions, personal preferences, and how you respond to previous treatments. Each medication offers distinct benefits and risks—such as method of administration, safety considerations, and approved uses—that can make one a better fit for certain individuals. A conversation with your healthcare provider is essential to determine which option aligns best with your needs, lifestyle, and treatment goals.
Dupixent may be preferred if:
- You are comfortable with injections.
- Treatment is for a child under 12 for atopic dermatitis.
- You have a history of blood clots or cancer.
- You have allergic conditions like asthma or nasal polyps.
Rinvoq may be preferred if:
- You dislike injections.
- You also have rheumatoid arthritis, Crohn’s, or ulcerative colitis.
- You did not respond to Dupixent or have failed other biologics.
Can You Switch or Take Both Together?
No combination therapy with both drugs is FDA-approved. However, switching from one to the other is possible and should be done under medical supervision to minimize risk and manage potential flares.
This is not all the information you need to know about Rinvoq and Dupixent for safe and effective use and does not take the place of your doctor’s directions. Review the full patient medication guide and discuss this information and any questions you have with your doctor or other health care provider.
Bottom Line
- Rinvoq may offer faster and greater short-term improvement for eczema but carries stricter safety warnings including risk of infections, blood clots, and cancer.
- Dupixent is trusted across a wider set of allergic conditions and age groups, with a strong safety profile.
- Administration (pill vs. injection), side effects, and cost all differ.
- Both require close collaboration with your doctor to determine the best fit based on medical history, condition severity, and lifestyle preferences.
References
- Dupixent [package insert]. Updated June 2025. sanofi-aventis U.S. LLC. Accessed on July 30, 2025 at https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=595f437d-2729-40bb-9c62-c8ece1f82780
- Gade, A., Ghani H, Patel P, et al. Dupilumab. Updated 2024. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Accessed on July 30, 2025 at https://www.ncbi.nlm.nih.gov/books/NBK585114/
- Padda, I. S., Bhatt R, Patel P, et al. Upadacitinib. Updated 2024. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Accessed on July 30, 2025 at https://www.ncbi.nlm.nih.gov/books/NBK572088/
- Rinvoq [package insert]. Updated April 2025. AbbVie Inc. Accessed on July 30, 2025 at https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=2966aec7-2ef0-923c-d8ff-fe1a957bf095
- Silverberg, J. I., Bunick, C. G., Hong, H. C., Mendes-Bastos, P., Stein Gold, L., Costanzo, A., Ibrahim, N., Sancho, C., Wu, X., Han, Y., Levy, G., Altman, K., Calimlim, B., & Eyerich, K. 2024. Efficacy and safety of upadacitinib versus dupilumab in adults and adolescents with moderate-to-severe atopic dermatitis: week 16 results of an open-label randomized efficacy assessor-blinded head-to-head phase IIIb/IV study (Level Up). The British journal of dermatology, 192(1), 36–45. https://doi.org/10.1093/bjd/ljae404
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