Abrocitinib Drug Survival Significantly Higher Than Dupilumab for Atopic Dermatitis

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Abrocitinib has a significantly higher drug survival rate compared to that of dupilumab when treating those with atopic dermatitis, recent findings suggest, although there are certain benefits to choosing dupilumab.¹

These data were the result of research led by Qingjie Hu, from the department of allergy and rheumatology at the Chinese Academy of Medical Sciences and Peking Union Medical College in Nanjing, China. Hu et al. acknowledged the advancements in understanding atopic dermatitis in recent years, adding that Janus kinase (JAK)-1 inhibitors such as abrocitinib and upadacitinib and other drugs like dupilumab have transformed our treatment philosophy.

“They have shown effective responses in AD, with slight side effects compared to traditional immunosuppressants; however, drug survival studies comparing these two drugs are scarce,” Hu and colleagues wrote. “This retrospective study aimed to investigate the safety of abrocitinib and dupilumab and to compare the drug survival of these two drugs.”¹

Study Design

The investigators involved 197 adult trial participants in the age range of 18 and older with moderate-to-severe atopic dermatitis. 102 subjects were treated with dupilumab and 95 were given abrocitinib, with the former cohort being given an initial 600 mg subcutaneous loading dose followed by 300 mg injections on an every-2-week basis.

At the same time, the research team provided abrocitinib with an orally-administered dose at either 100 mg or 200 mg per-day, deciding upon the treatment’s dosage using severity of the disease along with body mass index (BMI). The participants with an over 30 BMI and/or a a score on the Scoring Atopic Dermatitis Index (SCORAD) over the age of 50 uears were given the higher 200 mg dose.

Throughout the study, participants were monitored by the team at the initiation, the 16-week mark, and the 24-week mark. Collection of data included information related to participants' disease duration, age, onset of disease, sex, SCORAD scores, atopic comorbidities, and rationale for treatment termination.

Abrocitinib Versus Dupilumab

Abrocitinib therapy’s rate of survival was significantly higher (80%) versus that of dupilumab therapy (49.02%) (P < .0001). Among the subjects treated with abrocitinib, those in the 200 mg arm of the study were noted as having a higher rate of survival than the 100 mg arm (86.67% compared to 78.75%).

Treatment with abrocitinib led to a rate of 76.68% in terms of drug survival among those with a SCORAD ≤ 50, when the research team compared based on severity of the condition. Additionally, the team reported 93.75% rate in those with severe disease (SCORAD > 50).

Among those given dupilumab, the rates identified by the investigators were 38.98% and 55.81%, respectively. The research team concluded that the principal reasons for dupilumab discontinuation had been failure of drug among 34.62%, clinical remission among 25%, and financial strain among 17.31%.

The team found that among those given abrocitinib, the principal reasons for termination were clinical remission among 47.37%, failure of drug among 21.05%, and other factors among 21.05%. Those treated with dupilumab were shown to have adverse events (AEs) such as transient exacerbation (2.94%) as well as mild cases of conjunctivitis (1.96%). Those on abrocitinib saw AEs such as acne (8.42%), abnormal liver function (3.16%), nausea (15.79%), and tonsillitis (2.11%).

Within their research, the investigators noted that 12.63% of the subjects were elderly and had been treated with abrocitinib. They found that while some mild AEs transpired such as dizziness, nausea, and toothache, there were no serious events such as thrombosis or cardiovascular problems. The team noted that this could possibly have resulted from the shorter duration.

The research team noted that this study's proportion of individuals showing poorer rates of response to dupilumab had been higher than previously reported rates.²

“Overall, from the perspective of drug efficacy and convenience, abrocitinib has advantages; while from a safety standpoint, dupilumab has advantages and is more favourable for children and elderly patients with underlying diseases,” the investigators concluded.

References

1. ^{Hu, Q., Gao, Y., Xu, K. and Yao, X. (2024), Drug survival of abrocitinib compared to dupilumab in adult patients with atopic dermatitis. J Eur Acad Dermatol Venereol. https://doi.org/10.1111/jdv.20265.}
2. ^{Silverberg JI, Guttman-Yassky E, Gadkari A, Kuznik A, Mallya UG, Mastey V, et al. Real-world persistence with dupilumab among adults with atopic dermatitis. Ann Allergy Asthma Immunol. 2021; 126(1): 40–45.}