Abrocitinib Effective for Eczema Patients with Inadequate Response to Upadacitinib, Dupilumab

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This research also included results from a sub-analysis of non-responders with hand eczema to dupilumab and upadacitinib.

Credit: Pexels

Credit: Pexels

Abrocitinib is effective as a daily practice treatment for atopic dermatitis even among patients with prior inadequate responses to upadacitinib or dupilumab therapy, according to recent findings. The treatment is also effective for those with hand eczema.1

These findings resulted from a new study conducted due to the lack of current daily practice data related to abrocitinib’s effects on individuals with atopic dermatitis, here also referred to interchangeably as eczema. This research was led by Esmé Kamphuis, MD, from the department of dermatology at the University Medical Center Groningen in the Netherlands.

The study also involved a sub-analysis looking specifically at hand eczema. Kamphuis and colleagues noted that over 50% of those within the clinical population reporting atopic dermatitis are known to have hand eczema.2

“The aim of this study is to evaluate the effectiveness and safety of abrocitinib in patients with (atopic dermatitis), including those with previous inadequate response to dupilumab or upadacitinib, in daily practice,” Kamphuis and colleagues wrote. “Furthermore, for a subgroup of patients with AD, the effectiveness ofabrocitinib on (hand eczema) was evaluated.”

Background and Methods

The investigators conducted a multicenter prospective study, looking at individuals with atopic dermatitis who had been given abrocitinib in the period March 2022 - June 2023. These patients had been enrolled at any 1 of 6 specific hospitals located in the Netherlands, with 3 of such centers being academic and 3 being non-academic centers.

Those with hand eczema who had been treated with abrocitinib at the University Medical Center Groningen (UMCG) were included for the specific purposes of the research team’s hand eczema sub-analysis. The research itself, part of the Dutch BioDay registry, was deemed to be a non-interventional study by the regional ethics committee.

Study subjects had been prescribed 200 mg of abrocitinib per-day, and adjustments had been made for comorbidities, age, and interactions with other medications. Systemic therapy prior to treatment with abrocitinib was discontinued, and there was a defined washout period for several different types of treatments.

Calcineurin inhibitors and topical corticosteroids were allowed to be used concurrently. Subjects had taken part in regular visits to clinics, and the investigators evaluated outcomes through the use of several different measures such as Investigator Global Assessment (IGA), Eczema Area and Severity Index (EASI), measures which were patient-reported, and monitoring for adverse events (AEs) and laboratory parameters.

Findings

The investigators ended up assessing a cohort of 103 individuals who had been sourced from the BioDay registry, distributing these participants over several different weeks: 95 by Week 4, 61 by Week 16, and 39 by Week 28. The team reported that 81.8% had, after 28 weeks, received a score of Eczema Area and Severity Index (EASI)-50.

The research team also found that by this same point, 57.6% of the subjects had achieved EASI-75 and 18.2% had achieved EASI-90. The team also noted that 62.9% were shown to have a weekly average pruritus numerical rating scale of 4 or less.

Abrocitinib efficacy was found not to have led to much variance between non-responders to dupilumab, to dupilumab-naïve individuals/responders, or between upadacitinib non-responders and upadacitinib-naïve individuals/responders. The team further reported that the mean Hand Eczema Severity Index scores were shown to have dipped from 27.4 ± 27.7 at baseline to 7.7 ± 12.1 by the 28-week mark (n = 31).

The investigators lastly found that 31.1% of the subjects had discontinued their course of treatment, with some citing reasons such as AEs (n=9), ineffectiveness (n=17), or a combination of both reasons (n=3). The team added that nausea was found to be most frequently reported as an AE, impacting 28 subjects.

“However, the majority of patients reported at least 1 AE,” they wrote. “Almost one-third of patients discontinued abrocitinib treatment. Future studies should focus on patients’ characteristics as possible predictors for effectiveness and AEs.”

References

  1. Kamphuis E, Boesjes CM, Loman L, et al. Real-world Experience of Abrocitinib Treatment in Patients with Atopic Dermatitis and Hand Eczema: Up to 28-week Results from the BioDay Registry. Acta Derm Venereol. 2024;104:adv19454. Published 2024 Feb 7. doi:10.2340/actadv.v104.19454
  2. Simpson EL, Thompson MM, Hanifin JM. Prevalence and morphology of hand eczema in patients with atopic derma-titis. Dermatitis 2006; 17: 123–127.
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