Treatment of giant cell arteritis: focus on upadacitinib

INTRODUCTION: Giant cell arteritis (GCA) is the most common primary vasculitis and is associated with substantial morbidity. Glucocorticoids play a central role in GCA, resulting in cumulative glucocorticoid exposures that far exceed those used in other rheumatic conditions. AREAS COVERED: This review summarizes current treatment strategies for GCA, with a particular focus on the Janus kinase (JAK) inhibitor upadacitinib. Evidence from randomized controlled trials, observational studies, and recent conference data is discussed, including efficacy, safety, and comparative considerations with established therapies such as tocilizumab. A structured literature PubMed search was conducted using the terms 'giant cell arteritis,' 'treatment,' and 'upadacitinib,' supplemented by relevant conference abstracts and guideline documents.Upadacitinib was approved in 2025 based on a phase 3 trial, demonstrating significantly higher rates of sustained remission and lower cumulative glucocorticoid doses compared to placebo. After re-randomization of patients in sustained remission, rapid flares were observed following discontinuation of upadacitinib. EXPERT OPINION: Upadacitinib represents an effective oral alternative to tocilizumab for reducing glucocorticoid burden, particularly in patients with relapsing GCA or in patients with GCA who have an increased risk of glucocorticoid-related toxicity, with less profound suppression of inflammatory markers than tocilizumab.