Upadacitinib shows superiority to dupilumab in atopic dermatitis
Upadacitinib showed superior efficacy to dupilumab after 16 weeks of treatment in atopic dermatitis, with higher levels of skin clearance and itch relief, according to a study.
“This new paper is important because it describes a blinded study where dupilumab, a leading biologic drug for patients with moderate-to-severe atopic dermatitis, was compared head-to-head with upadacitinib, an oral drug that is in development for the same indication,” Andrew Blauvelt, MD, MBA, of Oregon Medical Research Center and one of the study’s authors, told Healio in an email correspondence.
The multicenter, randomized, double-blinded, double-dummy, active-controlled, 24-week phase 3b Heads Up trial included 692 atopic dermatitis patients randomized to receive either upadacitinib (348) or dupilumab (344).
Of those in the upadacitinib group, a 75% improvement in the Eczema Area and Severity Index (EASI75) was recorded in 247 (71%) of patients, compared to 210 (61.1%) of those in the dupilumab group, with an adjusted difference of 10% (95% CI, 2.9%-17%; P=.006).
EASI75 at week 2 was also significantly greater for those in the upadacitinib group with 152 (43.7%) compared to 60 (17.4%) of those in the dupilumab group (P < .001).
The number of patients reaching EASI90 and EASI100 was also significantly greater at week 16 in the upadacitinib group with 211 (60.6%) and 97 (27.9%) compared to 133 (38.7%) and 26 (7.6%), respectively (P < .001 for both).
Significantly greater efficacy was also shown in all secondary endpoints including itch severity and skin clearance rates.
Adverse events included acne in the upadacitinib group and conjunctivitis in the dupilumab group. Serious adverse events were recorded in 2.9% of the upadacitinib group and 1.2% of the dupilumab group.
“Upadacitinib proved superior to dupilumab in both speed and magnitude of skin and itch improvements at all timepoints studied,” Blauvelt said. “These data ‘move the needle’ in terms of what’s possible in atopic dermatitis efficacy, especially for high levels of clearance like EASI 90 and EASI 100.”