Atopic dermatitis can have a significant impact on quality of life in adolescents, so new efficient treatments are needed to improve management of this chronic condition.
New research has now demonstrated the long-term efficacy and safety of upadacitinib, a JAK inhibitor normally used to treat rheumatoid arthritis, in treating moderate to severe atopic dermatitis in adolescents. The study, analysed data from three large phase 3 clinical trials over 76 weeks and demonstrated promising results for this patient population.
The three trials, Measure Up 1, Measure Up 2, and AD Up, involved a total of 542 adolescents aged 12-17 years, tested upadacitinib at 15 mg and 30 mg doses. By week 76, a high proportion of participants achieved significant skin clearance. Results demonstrated that 89.1%, 84.4%, and 87.8% of adolescents for each trial respectively, taking 15 mg upadacitinib achieved EASI-75 (75% reduction in Eczema Area and Severity Index score). For the 30 mg dose, these rates were even higher at 96.1%, 93.6%, and 82.7%, respectively. The safety profile was generally consistent with previous findings. Acne was the most common adverse event, typically mild and rarely leading to treatment discontinuation. Importantly, no major adverse cardiovascular events, venous thromboembolic events, active tuberculosis, lymphoma, kidney dysfunction, or gastrointestinal perforations were observed. Height measurements up to week 76 did not suggest any notable impact on adolescent growth.
These results indicate that upadacitinib may provide an effective long-term treatment option for adolescents with moderate to severe atopic dermatitis, with a favourable benefit-risk profile. However, the researchers note certain limitations, including the relatively small sample size compared to adult studies and the exclusion of patients under 12 years or weighing less than 40 kg.
Further research and longer-term studies are needed to fully establish the role upadacitinib in clinical practice for adolescent atopic dermatitis.
Reference
Paller et al. Upadacitinib in adolescents with moderate to severe atopic dermatitis: analysis of 3 Phase 3 randomized clinical trials through 76 weeks. JAMA Dermatol. Published online October 23, 2024. doi:10.1001/jamadermatol.2024.3696
