Effectiveness and tolerance of Janus kinase inhibitors for the treatment of recalcitrant atopic dermatitis in a real-life French multicenter adult cohort

Vanlerberghe, Julia; Dezoteux, F.; Martin, Claire; Soria, Angèle; Tétart, F.; Modeste-Duval, Anne-Bénédicte; Bursztejn, Anne‐Claire; Miséry, Laurent; Aubin, F.; Lasek, A.; Leleu, C.; Du‐Thanh, Aurélie; Pasteur, Justine; Pralong, P.; Nosbaum, Audrey; Droitcourt, Catherine; Viguier, Manuelle; Tauber, M.; Sénéschal, Julien; Barbarot, S.; Staumont‐Sallé, D.

doi:10.1016/j.jaad.2022.10.034

Cited by 11 publications

(6 citation statements)

References 4 publications

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“…These results are even better than those of the AD Up trial [ 4 ] where 40% and 59% of patients achieved a vIGA-AD of 0 or 1 at week 16, respectively, with upadacitinib 15 mg and 30 mg, combined with topical corticosteroids. The effectiveness and tolerance data are also comparable to those of other real-life studies with upadacitinib [ 6 – 11 ]. It adds further evidence to recent studies that have shown a superior efficacy of upadacitinib 30 mg to that of baricitinib 2 or 4 mg, dupilumab or tralokinumab [ 12 – 14 ].…”

Section: Discussionsupporting

confidence: 78%

Real-Life Effectiveness and Tolerance of Upadacitinib for Severe Atopic Dermatitis in Adolescents and Adults

et al. 2023

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Introduction:The efficacy and safety of upadacitinib in atopic dermatitis have been defined in clinical trials, but long-term real-life experience, essential for clinical decision-making, is still limited. We aimed to assess the effectiveness and tolerance of upadacitinib in a real-life cohort of adults and adolescents with severe atopic dermatitis in whom previous systemic therapies largely failed. Methods: Retrospective cohort study collecting data from adults and adolescents treated with upadacitinib 15 or 30 mg per day between July 2021 to August 2022. The outcomes for effectiveness were evaluated by the percentage of patients who achieved a validated Investigator's Global Assessment for atopic dermatitis (vIGA-AD) of 0 (clear) or 1 (almost clear) and/or an improvement of at least 75% on the Eczema Area and Severity Index (EASI 75) at the end of the follow-up. All treatment-emergent adverse events were collected. Results: A total of 29 patients were included (22 adults and 7 adolescents), with a median follow-up of 54.4 weeks. At the end of the follow-up, 23 patients (79.3%) reached a vIGA-AD of 0/1, and 24 patients (82.7%) achieved EASI 75. Among patients treated with upadacitinib after initial failure of first-and/or secondline treatment with biologics or baricitinib, 5/7 patients (71.4%) reached a vIGA-AD score of 0/1. Disease control was slightly better in adults than in adolescents (81.8% vs 71.4% reached the efficacy endpoint, respectively). Response rate in patients with upadacitinib 15 mg seemed better than in clinical trials or network metaanalysis. Safety data were reassuring; lipid changes were the most frequent adverse event. Conclusion: This real-life study confirms the effectiveness of upadacitinib, particularly for the treatment of atopic dermatitis recalcitrant to conventional systemic agents, biologics or baricitinib. Induced lipid changes require close follow-up.

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Section: Discussionsupporting

confidence: 78%

Real-Life Effectiveness and Tolerance of Upadacitinib for Severe Atopic Dermatitis in Adolescents and Adults

et al. 2023

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“…Several studies have analyzed upadacitinib in clinical practice. Vanlerberghe et al [22] included AD patients from 18 French centers, 54 of whom were treated with the 15-mg dose and 12 with the 30-mg dose. Approximately 75% of the patients had received cyclosporine and dupilumab, and more than half had received at least 3 systemic/biological treatments.…”

Section: Baricitinibmentioning

confidence: 99%

Updated Review on Treatment of Atopic Dermatitis

Hita¹,

Galán‐Gutiérrez²,

Dodero-Anillo³

et al. 2023

J Investig Allergol Clin

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Atopic dermatitis (AD) is a chronic or chronically recurrent Inflammatory dermatosis associated with multiple triggers that has a complex pathophysiological mechanism. It is characterized by a heterogeneous clinical expression, signs, and symptoms. Its etiology and pathogenesis are complex and are influenced by multiple immune-mediated factors. Treatment of AD can also be complex, given the high number of available drugs and multiple therapeutic targets. In this review, we summarize current literature on the efficacy and safety of topical and systemic drugs to treat moderate-to-severe AD. We begin with topical treatments such as corticosteroids and calcineurin inhibitors and subsequently address the latest systemic treatments, such as Janus kinase inhibitors (upadacitinib, baricitinib, abrocitinib, gusacitinib) and interleukin (IL) inhibitors, which have proven efficacious in AD, namely, dupilumab (IL-4 and IL-13), tralokinumab (IL-13), lebrikizumab (IL-13), and nemolizumab (IL-31). Given the large number of drugs available, we summarize the pivotal clinical trials for each drug, evaluate recent real-world experience in terms of safety and efficacy for purposes of compilation, and provide evidence to guide the optimal choice of therapy.

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“…Vanlerberghe et al 37 published a multicenter French real-world study to evaluate the effectiveness of JAK inhibitors for the treatment of severe AD. After three months of treatment, the Authors found that 35.7% and 7.1% of patients achieved EASI 75 and EASI 90, respectively, with the dosage of 15 mg, while 57.1% reached EASI 75 and EASI 90 with upadacitinib 30 mg. Only a small proportion of patients reached 6 months of treatment, with 37.5% and 100% of patients achieving EASI 75 with upadacitinib 15 and 30 mg, respectively.…”

mentioning

confidence: 99%

“…23,29 In a French retrospective observational study, four patients discontinued treatment with upadacitinib due to cytolysis, hypercholesterolemia, dyspnea, and a facial papular eruption. 37 In the cohort studied by Napolitano et al, 35 three patients discontinued treatment due to anemia, restless leg syndrome, and elevated blood CPK. In a Spanish retrospective observational study, one patient discontinued treatment due to asthenia and weakness.…”

mentioning

confidence: 99%

Practical Use of Upadacitinib in Patients with Severe Atopic Dermatitis in a Real-World Setting: A Systematic Review

Ibba,

Gargiulo,

Vignoli

et al. 2024

CCID

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Upadacitinib is a selective Janus kinase inhibitor approved for the treatment of severe atopic dermatitis (AD). This systematic review aims to summarize the most recent data in terms of effectiveness and safety of upadacitinib in the treatment of severe AD in a real-world setting. The review included a comprehensive search of databases, including PubMed, Google Scholar and Web of Science, according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The literature search initially identified 242 studies. Of these, 214 were excluded after reviewing their titles and abstracts. We then conducted a full-text review of 25 studies, of which 17 met our inclusion criteria and were therefore included in our systematic review. The analysis of real-world studies showed high effectiveness of upadacitinib, in terms of both clinical signs and subjective symptoms, in different patient populations, including those resistant to other treatments. No new significant safety concerns have emerged as compared to randomized clinical trials.

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Effectiveness and tolerance of Janus kinase inhibitors for the treatment of recalcitrant atopic dermatitis in a real-life French multicenter adult cohort

Cited by 11 publications

References 4 publications

Real-Life Effectiveness and Tolerance of Upadacitinib for Severe Atopic Dermatitis in Adolescents and Adults

Real-Life Effectiveness and Tolerance of Upadacitinib for Severe Atopic Dermatitis in Adolescents and Adults

Updated Review on Treatment of Atopic Dermatitis

Practical Use of Upadacitinib in Patients with Severe Atopic Dermatitis in a Real-World Setting: A Systematic Review

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