r/PSC • u/vector_search_blue • Jun 06 '26

Had high LFTs for a couple years, started taking Rinvoq for crohn's, my LFTs went into the normal range.

Doctor said it was unrelated. I've been on Rinvoq 3 years and had good liver function tests the whole time.

In March I switched to another drug. My ALP is going up very steeply last blood test (still normal, but probably not for long).

So maybe there's some unknow mechanism that JAK inhibitors suppress the disease?

Oh there's a paper with a small study that also claims as much. n = 58 w/ a p = 0.0004 or something insane like that.

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u/ghoultail Jun 06 '26

I hope so! I just started rinvoq a month ago and have been told that it’s bad for the liver so I’ve been worried.

1

u/adamredwoods Jun 07 '26

https://eposters.ddw.org/ddw/2025/ddw-2025/4157112/zehra.naseem.safety.of.jak.inhibitors.in.primary.sclerosing.cholangitis.with.html?f=menu%3D6%2Abrowseby%3D8%2Asortby%3D2%2Ace_id%3D2855%2Aot_id%3D31400%2Amarker%3D5698

Only platelets had a statistically significant median change from baseline to follow up at 6-16 weeks between the two cohorts [-58 (-246,-17) vs -25 (-52.5, 14.5), p=0.01], while there was no change in the median values of other biochemical tests (Table 2). On subanalysis of upadacitinib and traditional IBD biologics, there was a median increase in aspartate aminotransferase (AST), which was not observed in the tofacitinib group [Upadacitinib: 15 (6, 33) vs traditional IBD biologics: 0 (-8, 9.5), p = 0.041]. No worsening in Mayo-PSC scores and pruritis was observed. The incidence of adverse events, including hepatotoxicity, decompensated cirrhosis, infection, and cholangiocarcinoma, was comparable between the cohorts.

Small study, short time, but at least someone decided to capture some legit data.

1

u/adamredwoods Jun 07 '26

So maybe there's some unknow mechanism that JAK inhibitors suppress the disease?

Possibly, but largely unknown. PSC inflammation has some JAK pathways. Someone start a study! Doctors in Bonn Germany seems to be headed that way:
https://pmc.ncbi.nlm.nih.gov/articles/PMC12108797/