Effect of Upadacitinib on Atopic Hand Eczema in Patients With Moderate to Severe Atopic Dermatitis
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Approximately 60% of patients with atopic dermatitis have involvement of the hands adding to the burden of disease.
OBJECTIVE
This analysis aims to evaluate the effect of upadacitinib monotherapy on atopic hand eczema in patients with moderate-to-severe AD over 16 weeks in the Measure Up 1 and 2 studies.
METHODS
Data from patients (ages 12-75) randomised 1:1:1 to receive upadacitinib 15 mg, 30 mg, or placebo once daily in the Measure Up 1 and 2 studies were analyzed for impact on atopic hand eczema assessed using the Hand Eczema Severity Index (HECSI). The percent change from baseline in HECSI score was a prespecified additional endpoint at all visits. The proportion of patients with at least a 75% improvement in HECSI score (HECSI 75) was evaluated post-hoc.
RESULTS
Patients treated with upadacitinib 15 mg or 30 mg experienced greater improvement in HECSI score compared to placebo as early as week 1, which was maintained through week 16. At week 16, the mean change from baseline in HECSI score for patients receiving upadacitinib 15 mg, 30 mg, and placebo was -68%, -74%, and -15% in Measure Up 1 and -68%, -74%, and +21% (positive change indicates worsening for placebo) in Measure Up 2, respectively. A greater proportion of upadacitinib-treated patients achieved HECSI 75 compared to placebo at all timepoints beginning at week 1 through week 16.
CONCLUSIONS
Upadacitinib 15 mg and 30 mg monotherapy provided rapid and sustained improvement in atopic hand eczema compared to placebo through week 16 in patients with moderate-to-severe AD. At week 16, the observed mean improvements in HECSI score in upadacitinib-treated patients were clinically meaningful based on previous interpretability studies. These results suggest that upadacitinib may be an effective treatment option for atopic hand eczema in patients with moderate-to-severe AD.
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Additional Info
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Effect of Upadacitinib on Atopic Hand Eczema in Patients With Moderate-to-Severe Atopic Dermatitis: Results From Two Randomised Phase 3 Trials
J Eur Acad Dermatol Venereol 2023 May 15;[EPub Ahead of Print], EL Simpson, K Rahawi, X Hu, AD Chu, C Nduaka, S Jazayeri, P Lio, C Lynde, MLA SchuttelaarFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
When this got published, my main thought was that the data were nice to have, but to be honest, kind of boring. Takeaway: Upadacitinib works just as well for hand eczema as it does for eczema anywhere else on the body.
For anybody who has used systemic Janus kinase (JAK) inhibitors, it's pretty obvious they have outstanding efficacy for dermatitis in any location. This article is sort of like a newspaper headline of "Dog Bites Man" - not so interesting and is exactly what you expected. If upadacitinib had not worked, that would have been a "Man Bites Dog" headline - very interesting. But, so far, I have not seen anything in the literature or my clinical experience to suggest that any location of dermatitis is less responsive to JAK inhibition.