The following is a summary of “Efficacy and safety of switching from dupilumab to upadacitinib versus continuous upadacitinib in moderate-to-severe atopic dermatitis: Results from an open-label extension of the phase 3, randomized, controlled trial (Heads Up),” published in the SEPTEMBER 2023 issue of Dermatology by Blauvelt, et al.

There was a need to understand better the use of upadacitinib and the process of switching from dupilumab to upadacitinib in patients with moderate-to-severe atopic dermatitis (AD). For a study, researchers sought to assess the long-term safety and efficacy of continuous upadacitinib at 30 mg and the outcomes of switching to upadacitinib after 24 weeks of dupilumab treatment.

The study included adults who had completed a phase 3b clinical trial comparing oral upadacitinib 30 mg to injectable dupilumab 300 mg (Heads Up) and had entered a 52-week open-label extension (OLE) phase. During the open-label period, all patients received upadacitinib at 30 mg. This report presents the results of a prespecified interim analysis conducted 16 weeks into the OLE phase.

Patients (totaling 239) who continued with upadacitinib maintained high skin and itch response levels. Additionally, patients (totaling 245) who switched from dupilumab to upadacitinib experienced further incremental improvements in clinical responses within 4 weeks of starting upadacitinib. Most patients without sufficient clinical responses with dupilumab could do so with upadacitinib. Importantly, the safety profile of upadacitinib remained consistent with previous phase 3 studies on AD, and no new safety concerns were identified during the up to 40 weeks of the study (which included the first 16 weeks of the OLE).

The study demonstrated that continuous upadacitinib treatment maintained clinical responses in patients with AD for up to 40 weeks. Furthermore, patients, regardless of their previous response to dupilumab, experienced improved outcomes when switched to upadacitinib, and the safety profile of upadacitinib remained consistent with previous research.

Source: jaad.org/article/S0190-9622(23)00966-0/fulltext