Abrocitinib vs. Dupilumab will be an important question for many prescribing doctors with the expected FDA approval of abrocitinib soon.
We have extensively discussed atopic dermatitis (eczema) in the past. For many years only topical therapies were available for this condition. Topical steroids are the mainstays of treatment, and after many years newer topical therapies were developed such as Elidel and Eucrisa.
A breakthrough in eczema treatment occurred a few years ago with the development of Dupixent (Dupilumab). This is a systemic injectable medication that targets eczema from “within”. This was approved for moderate to severe atopic dermatitis.
Dupilumab has been a ground breaking treatment for eczema sufferers, as it has reversed many symptoms of patients who had a widespread distribution of atopic dermatitis and the topical therapies have failed them. Most patients with eczema do not want to take other therapies such as systemic steroids, immunosuppressants and/or phototherapy because of side effects.
We recently wrote about a new class of atopic dermatitis medication set to be released soon, these are the oral Janus kinase (JAK1) inhibitors. Abrocitinib will likely be the first one and it reduces interleukin-4 and interleukin-13 signaling.
There will be others to follow as well. Baricitinib for Atopic Dermatitis (Eczema)
An important question to be answered is how will abrocitinib vs. dupilumab compare?
In the New England Journal of Medicine a study was published titled “Abrocitinib versus Placebo or Dupilumab for Atopic Dermatitis” investigated this question.
It was a phase 3 double-blind trial of patients with eczema that was unresponsive to topical agents to receive 200mg or 100mg of abrocitinib orally once daily, 300mg of dupilumab subcutaneously every other week (after a 600mg loading dose) or placebo. The endpoint was the Investigator’s Global Assessment (IGA) and an Eczema Area Severity Index-75 (EASI-75).
A total of 838 patients were enrolled. The results showed that the 200mg dose but not the 100mg dose of abrocitinib was superior to dupilumab with respect to itch at week 2. Neither abrocitinib dose differed significantly from dupilumab with respect to most other key secondary end point comparisons at week 16. Nausea occurred in 11.1% of patients in the 200mg abrocitinib group.
Based on this study abrocitinb vs. dupilumab long term did not show much of a difference up to 16 weeks for the 200mg dose. (This study was funded by Pfizer).
These 2 medications have very different administrations (daily oral vs. injectable every 2 weeks) and mechanisms of actions. But they will both be indicated for the same disease of moderate to severe atopic dermatitis. Choosing abrocitinib vs. dupilumab may also depend on the side effects of each medication if they have similar efficacy. We will find out more as more patients are enrolled in studies.
While this study provides insights about the differences of dupilumab vs. abrocitinib in the short term, longer term studies are required to understand the outcomes. The author of the study Dr. Bieber said “This study confirms the impressive efficacy of abrocitinib in combination with topical therapies and appears to show distinct advantages in terms of the rapidity of itch relief compared to standard of care.”