Experts discuss the long-term efficacy and safety of abrocitinib and upadacitinib in atopic dermatitis (AD), with sustained monotherapy results showing significant improvements in Investigator Global Assessment (IGA), Eczema Area and Severity Index (EASI), and Validated IGA-AD (vIGA-AD) scores. They also consider the safety profiles and potential risks, particularly in older patients, for long-term use of JAK inhibitors.
How do the long-term efficacy data compare with other treatment options for AD? What are your thoughts on sustained results achieved with monotherapy?
Abrocitinib
96-week data showed more patients were able to achieve IGA 0/1 and EASI-75, 90, and 100 with abrocitinib monotherapy than those who added topical therapy.
Upadacitinib
The 188-week data showed that a high proportion of patients on upadacitinib monotherapy were able to achieve EASI-75 (86.3% and 89%) and vIGA-AD 0/1 (59.5% and 61.8%).
How has the long-term safety of abrocitinib and upadacitinib affected your comfort level of keeping patients on JAK inhibitors long-term to treat AD? Are there certain patient types that might not be appropriate for long-term use?
Abrocitinib 4-year safety
Incidence rates for malignancy, major adverse cardiac events (MACE), and venous thromboembolism (VTE) remain low but were numerically higher for patients older than 65 years.
Adverse event rates are generally consistent between 100 mg, 200 mg, and variable dose cohorts, with a dose-dependent response for herpes zoster and herpes simplex infections.
Upadacitinib 6-year safety
Incidence rates for malignancy, MACE, and VTE remain low (≤0.5 patients per 100 patient-years) and generally reflect the background observations of these events in the overall AD population.
Adverse event rates are generally consistent between 15-mg and 30-mg doses (slightly higher herpes zoster rates with 30-mg dose