Upadacitinib Provides Greater Efficacy Compared with Dupilumab for Atopic Dermatitis

Jacob P. Thyssen

In a new study, upadacitinib demonstrated greater and more rapid efficacy in patients with atopic dermatitis (AD) when compared with dupilumab. Improvements were observed as early as week 1 and maintained through week 16.

Both treatments showed tolerable safety as in the phase 2 and 3 trials, but when evaluated in four body regions on patients, upadacitinib surpassed dupilumab in all of them.

The team of investigators, led by Jacob Thyssen, Department of Dermatology, Bispebjerg Hospital, aimed to examine which treatment was superior for skin clearance in four body regions in adults with moderate to severe atopic dermatitis.

The Phase 3b Heads Up Study

In the Heads Up phase 3b study, investigators observed both drugs over 24 weeks. Patients were randomized 1:1 to receive upadicitinib 30 mg orally on a daily basis or dupilumab 300 mg through subcutaneous injection every 2 weeks following the initial loading dose.

The primary endpoint for efficacy was achievement of 75% reduction in EASI for 4 body regions including head and neck, trunk, upper limbs and lower limbs, through week 16.

The NRI-C (Non-Responder Imputation incorporating Multiple Imputation to handle missing data due to COVID-19) was used to measure the endpoints and safety was assessed as treatment-emergent adverse events (AEs) in all patients receiving ≥1 dose of study drug.

The Results

A total of 692 patients were randomized to receive one treatment or the other, with greater proportions of those on upadicitinib achieving EASI75 for each region being evaluated from week 1-week 16.

Results showed that the primary endpoint for the head and neck was demonstrated by 24.8% of patients on upadicitinib compared with 10.6% of those on dupilumab by week 1 then 64.8% and 52.5% at week 16, respectively.

In the trunk region, 23.9% on upadacitinib vs 10.9% on dupilumab reached EASI75 at week 1 and by week 16, 70.0% and 60.5%.

Observing the upper limb, percentages were 17.3% vs 7.8% at week 1 and 70.4% vs 58.7% at week 16. In the lower limb, 18.5% and 8.1% achieved EASI75 at week 1 and 72.4% compared with 61.2% did so at week 16.

"UPA provided greater and more rapid efficacy than DUPI in all four body regions in patients with moderate-to-severe AD as early as week 1 and maintained through week 16. Both UPA and DUPI had tolerable safety," investigators concluded.