Eczema Patients Treated with Upadacitinib in Real World Setting See Significant Improvements

Individuals with moderate-to-severe atopic dermatitis (AD) given upadacitinib treatment within real-world settings may experience relief from itch as well as improvements in skin clearance, according to new late breaking data presented at the Revolutionizing Atopic Dermatitis (RAD) 2024 Annual Meeting in Chicago.¹

These patients also were reported to have increased levels of satisfaction with the degree as well as the timing of their relief from itch and clearance, highlighting the patient-reported outcome element of this study. These findings from the SCALE-UP (Surveying the Clinically Relevant Patient-Reported Outcomes and Long-Term Effectiveness of Upadacitinib in Atopic Dermatitis) study highlight the potential benefit of this drug’s use in real-world settings.

The disease of atopic dermatitis itself is known to be a long-lasting inflammatory condition that impacts one’s life quality substantially due to symptoms such as itch. The drug, upadacitinib, is an oral Janus kinase (JAK) inhibitor, which is US Food and Drug Administration (FDA)-approved for eczema and has previously been successful in achieving the primary endpoints of previous research.²

Despite such findings, the investigators of SCALE-UP noted that outcomes of clinical trials may not always reflect the experiences of patients in the real world. Due to this fact, they acknowledged the value of augment clinical trial findings with real-world evidence, hence their exploration of this study and its assessment of patient-reported outcomes.

Design

The SCALE-UP trial was an observational study in which the investigators, led by Jonathan Silverberg, MD, PhD, the director of clinical research for George Washington University’s School of Medicine and Health Sciences, assessed adults with moderate-to-severe atopic dermatitis. These subjects had been a part of a patient support program (PSP) for upadacitinib within the US.

The investigators gave a single-time online questionnaire to subjects to access data on their experiences with upadacitinib, with emphasis on improvements in subjects’ pruritus and skin clearance notes. The survey also inquired about the time taken for such improvements as well as levels of patient satisfaction.

The participants were required to have been prescribed and actively been implementing upadacitinib for their skin condition, to have been 18 years of age, and to have been involved in the PSP for 2 - 12 months. The research team’s cross-sectional trial involved a total of 204 individuals, with average ages of subjects being 45.3 years and average age at the time of diagnosis being 30.3 years.

The investigators noted that 70.1% had been female, adding that among 50.5% of patients, upadacitinib therapy had lasted between 2 - 6 months. It lasted between 6 - 12 months for 49.5% of the participants.

In the beginning, the research team had noted that 94.6% began with a 15 mg dose of the drug, and 3.9% with 30 mg. A total of 79.4% at the time of the survey’s implementation had been on the 15 mg dose, with 19.6% having been on 30 mg.

They had the subjects self-report their skin tones, which were: pale white among 9.8%, white for 39.7%, light brown for 23.5%, moderate brown for 18.1%, dark brown for 5.9%, and deeply pigmented/black for 2.5%. The team reported that 36.8% of the participants had been utilizing topical corticosteroids.

Findings

After treatment, the investigators found that 94.6% of the participants had reported an improvement in their level pruritus, adding that 86.8% had commented "Very much" or "Much" under their level of improvement, and 7.8% with the "Minimally" improved response. Among those reporting relief, 87.0% noted single week improvement and 27.5% saw such improvements within a single day.

The research team also found that 37.8% had improved within 2-3 days and 21.8% saw the same thing within 4-7 days. Levels of participant satisfaction with the degree and speed of improvements to pruritus were noted as high, given that 87.0% and 86.0% of subjects, respectively, reporting being satisfied "Extremely" or "Very".

90.7% of participants reported clear skin following their initiation of upadacitinib therapy. The investigators reported that 81.4% had noted they had "Very much" or "Much" clearer skin, adding that 9.3% noted that their skin had cleared up "Minimally".

Among this group, 89.2% reported having clearer skin within a 2-week timeframe, with 30.8% noting such results 3 days in, 36.8% within a 4-7 day span, and 21.6% within an 8-14 day span. Levels of participant satisfaction were also found to be higher, in addition to the speed of clearance, with 83.8% and 83.2% of subjects, respectively, noting that they had been "Extremely" or "Very" satisfied.

References

1. ^{Silverberg J, Calimlim B, Bunick C, et al. Real-world patient experience of upadacitinib-treated adults with atopic dermatitis: results from the SCALE-UP study. Revolutionizing Atopic Dermatitis (RAD) 2024 Annual Meeting June 8 – 10, 2024. Chicago, IL.}
2. ^{New Data Show RINVOQ® (upadacitinib) Demonstrated Superiority Versus DUPIXENT® (dupilumab) Across Primary and All Secondary Endpoints in an Open-Label Head-to-Head Atopic Dermatitis Study. AbbVie. April 25, 2024. https://news.abbvie.com/2024-04-25-New-Data-Show-RINVOQ-R-upadacitinib-Demonstrated-Superiority-Versus-DUPIXENT-R-dupilumab-Across-Primary-and-All-Secondary-Endpoints-in-an-Open-Label-Head-to-Head-Atopic-Dermatitis-Study. Date accessed: April 25, 2024.}