Patients see atopic dermatitis improvement with switch from dupilumab to upadacitinib
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Key takeaways:
- Patients with continuous upadacitinib maintained EASI improvements.
- The percentage of patients that switched to upadacitinib from dupilumab and achieved EASI 90 increased from 66.4% to 87.8% after 4 weeks.
Patients with moderate to severe atopic dermatitis that switched from dupilumab to upadacitinib experienced significant improvement in efficacy and itch as early as week 4 of treatment, according to a study.
“Dupilumab was the first biologic approved to treat [atopic dermatitis (AD)]; however, after 16 weeks of treatment, fewer than 40% of patients achieve clear or almost clear skin and maximal response is not observed until after week 12,” Andrew Blauvelt, MD, MBA, investigator at the Oregon Medical Research Center, and colleagues wrote.
While dupilumab is still regarded as a highly effective biologic in this indication, according to the study, there are other treatment options available such as upadacitinib, an oral, selective Janus kinase inhibitor that is also approved to treat adolescents and adults with moderate to severe AD.
In this 16-week interim analysis of a 52-week open label extension (OLE) study of 484 adults with moderate to severe AD who completed the phase 3b Heads Up trial, researchers evaluated the long-term safety and efficacy of continuous upadacitinib at 30 mg and of switching to upadacitinib after 24 weeks of dupilumab.
After 24 weeks of receiving once-daily upadacitinib 30 mg, 239 patients continued the same dosage. Additionally, 245 patients switched from subcutaneous dupilumab 300 mg every other week to once-daily upadacitinib 30 mg at week 22.
According to the study, patients on upadacitinib saw a baseline EASI score of 30.5 improve to 2.4 at week 24. Those who continued on the drug maintained this improvement with a score of 2.7 at week 16 of the OLE, and 91% of these patients reported an EASI score of 7 or less at the same time point.
Additionally, researchers found that 73.6% of patients receiving continuous upadacitinib achieved EASI 90 and 54.2% achieved a Worst Pruritus-Numerical Rating Scale (WP-NRS) score of 0 or 1 in the extension analysis.
Those patients who switched from dupilumab to upadacitinib in the OLE continued to demonstrate an improvement in EASI, according to the study, with a mean EASI score of 28.8 at baseline, 3.29 at week 24 of Heads Up and 1.09 at the end of the 16-week extension analysis.
The proportion of patients that switched treatment and achieved EASI 90 increased from 66.4% at week 24 of Heads Up to 87.7% by the end of the 16-week analysis. This jump in EASI 90 was also seen in these patients within 4 weeks of switching biologics, according to the study.
Additionally, the researchers found that the percentage of patients that switched treatments and achieved a WP-NRS of 0 or 1 increased from 33.3% to 66.7% after 4 weeks of treatment.
The study reports that the safety profile of upadacitinib through the 16-week analysis was consistent with previously published phase 3 AD studies with no new safety risks.
The most common adverse events reported in patients that switched from dupilumab to upadacitinib included acne, worsening AD, blood creatinine phosphokinase increase and nasopharyngitis. One patient in the study died due to bone tuberculosis, and this death was not considered to be related to the study drug, according to the researchers.
“Upadacitinib provides greater efficacy compared with dupilumab, has a favorable benefit-risk profile, and patients, regardless of prior dupilumab response status, experienced improved outcomes when switched to upadacitinib,” Blauvelt and colleagues concluded.
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