Upadacitinib is an oral JAK1 inhibitor being developed for patients with severe atopic dermatitis. Multiple phase 2 randomized placebo controlled studies have examined the efficacy of upadacitinib in adults and adolescent patients with moderate to severe atopic dermatitis.
Published in The Lancet, 2 replicate 16-week trials showed that monotherapy with upadacitinib improved symptom and disease severity compared to placebo. They also found that the combination of upadacitinib and topical steroids, was better than placebo and topical steroids alone.
Upadacitinib was well tolerated in all trials as well.
We have discussed the oral JAK1 inhibitors in the past with the blog post, Abrocitinib for Atopic Dermatitis by Pfizer
Rinvoq and Cibinqo are the first oral drugs on the market approved for atopic dermatitis. There are a host of other medications being studied right now for eczema. New treatments for eczema on the horizon
Eczema or atopic dermatitis for many years has been treated with topical medications only. Topical corticosteroids are the mainstays of treatment, but later drugs that were developed have been Elidel, Protopic and Eucrisa.
Since then the first biological medication was approved, Dupixent. This was the first drug to treat eczema from “within” and not just topically. Researchers have come to realize that atopic dermatitis is not just a disease that is topically related, but from an internal systemic inflammation. So many of the new products being developed are treating eczema systemically.
Upadacitinib is already FDA for the treatment of moderate to severely active rheumatoid arthritis. It was approved in the United States and Europe in 2019. It is sold under the name, Rinvoq. It is also being investigated for rheumatoid arthritis, Crohn’s disease, ulcerative colitis, atopic dermatitis, psoriatic arthritis, axial SpA Giant Cell Arteritis and Takayasu Arteritis.
The drug manufacturer is AbbVie. Common side effects include upper respiratory tract infections (common cold, sinus infections), nausea, cough, and fever.
Upadacitinib’s brand name for atopic dermatitis will be the same name that it is sold under rheumatoid arthritis, Rinvoq.
Upadacitinib and Abrocitinib are the first oral JAK inhibitors approved for eczema and there will likely be many in this category in the future. It is dosed initially at 15 mg and if that doesn’t work the physician can increase it to a 30 mg dose. The main concern with this drug category is potential side effects, this should be discussed with your doctor as well as potential drug interactions.
A big question will be how do JAK inhibitors compare to Dupixent? In a previous blog post we compared these two classes of medications. Abrocitinib vs. Dupilumab for Atopic Dermatitis
A clinical study of Upadacitinib was studied head to head with Dupixent, and the results showed, during 16 weeks of treatment, upadacitinib demonstrated superior efficacy vs dupilumab in patients with moderate-to-severe AD, with no new safety signals.