For patients with moderate-to-severe atopic dermatitis, upadacitinib is well tolerated and provides superior efficacy compared with dupilumab, according to a study published online Aug. 4 in JAMA Dermatology.

Andrew Blauvelt, M.D., from the Oregon Medical Research Center in Portland, and colleagues randomly assigned 692 patients with moderate-to-severe atopic dermatitis who were candidates for systemic therapy to oral upadacitinib (30 mg once daily; 348 patients) or subcutaneous dupilumab (300 mg every other week; 344 patients). The study was conducted at 129 centers located in 22 countries from Feb. 21, 2019, to Dec. 9, 2020.

The researchers found that at week 16, 71.0 and 61.1 percent of the participants receiving upadacitinib and dupilumab, respectively, achieved 75 percent improvement in the Eczema Area and Severity Index (EASI75). The superiority of upadacitinib versus dupilumab was demonstrated in all ranked secondary end points, including improvement in the Worse Pruritus Numerical Rating Scale as early as week 1, achievement of EASI75 as early as week 2, and achievement of EASI100 at week 16. Patients receiving upadacitinib had higher rates of serious infection, eczema herpeticum, herpes zoster, and laboratory-related adverse events; patients who received dupilumab had higher rates of conjunctivitis and injection-site reactions.

"Upadacitinib is an effective treatment option for patients with moderate-to-severe atopic dermatitis and may help inform future treatment decisions," the authors write.

Several authors disclosed financial ties to biopharmaceutical companies, including AbbVie, which manufactures upadacitinib and funded the study.

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