Upadacitinib vs. Dupilumab in treating moderate-to-severe atopic dermatitis
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Reviewed by Dat Tien Nguyen, B.A, ScM.
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Posted on November 2nd, 2022
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Atopic dermatitis is majorly driven by the pro-inflammatory signal transduced by Interleukin-4. Thus, dupilumab, an antibody targeting IL-4 receptors has been used to treat the condition; however, only half of them achieve skin clearance after 16 weeks of usage. Thus, upadacitinib, a small molecule JAK inhibitor, can be a better alternative due to its broader spectrum of activity. Upadacitinib had already been approved for usage to treat patients with rheumatoid arthritis; thus, a comparative study was conducted, and its result had been published in the Journal of the American Medical Association - Dermatology.
The phase 3 clinical trial included 692 adults between the age of 18 and 75 years old, who had been diagnosed with moderate-to-severe atopic dermatitis. To be specific, more than 10% of the patient’s body surface area was affected, and their Eczema Area and Severity Index [EASI] and Worst Pruritus Numerical Rating Scale [NRS] scores are greater than 16 and 4 respectively. These patients are eligible for systemic treatment because they are unresponsive to topical treatment, or topical treatment is non-indicated. The patients were randomly assigned to receive either upadacitinib 30 mg or dupilumab 300 mg for 24 weeks. Upadacitinib is an extended release tablet that is orally administered once daily. Dupilumab is given intravenously initially at 600 mg, and every two weeks at 300 mg from week 2 to week 22. The study reported that more patients who received upadacitinib achieved a 75% reduction in their Eczema Area and Severity Index score [EASI75] at week 16. The onset of action of upadacitinib is faster because more in this group achieve EASI75 at the 2nd week of treatment. The superiority of the antibody therapy is observable in other outcomes: upadacitinib is superior in terms of Worst Pruritus NRS score improvement and EASI100 achievement. The fact that upadacitinib can be taken orally and dupilumab must be administered intravenously means that the adherence to the former is easier. However, due to its wider spectrum of action, the frequency of adverse events is higher in those in the upadacitinib group, who are at a higher risk of infection such as acne and herpes zoster. The study also reported that those in the dupilumab are at a higher risk of conjunctivitis and reaction at the site of injection.
The phase 3 clinical trial included 692 adults between the age of 18 and 75 years old, who had been diagnosed with moderate-to-severe atopic dermatitis. To be specific, more than 10% of the patient’s body surface area was affected, and their Eczema Area and Severity Index [EASI] and Worst Pruritus Numerical Rating Scale [NRS] scores are greater than 16 and 4 respectively. These patients are eligible for systemic treatment because they are unresponsive to topical treatment, or topical treatment is non-indicated. The patients were randomly assigned to receive either upadacitinib 30 mg or dupilumab 300 mg for 24 weeks. Upadacitinib is an extended release tablet that is orally administered once daily. Dupilumab is given intravenously initially at 600 mg, and every two weeks at 300 mg from week 2 to week 22. The study reported that more patients who received upadacitinib achieved a 75% reduction in their Eczema Area and Severity Index score [EASI75] at week 16. The onset of action of upadacitinib is faster because more in this group achieve EASI75 at the 2nd week of treatment. The superiority of the antibody therapy is observable in other outcomes: upadacitinib is superior in terms of Worst Pruritus NRS score improvement and EASI100 achievement. The fact that upadacitinib can be taken orally and dupilumab must be administered intravenously means that the adherence to the former is easier. However, due to its wider spectrum of action, the frequency of adverse events is higher in those in the upadacitinib group, who are at a higher risk of infection such as acne and herpes zoster. The study also reported that those in the dupilumab are at a higher risk of conjunctivitis and reaction at the site of injection.