Andrew Blauvelt, MD, MBA: The “New Era” of Dermatological Drugs

Dr. Blauvelt speaks on the results of the phase 3b Heads Up study, and the future of upadacitinib and dupilumab in atopic dermatitis management.

Last week, biopharmaceutical company AbbVie announced 24-week results from the phase 3b Heads Up study that evaluated the efficacy and safety of upadacitinib (RINVOQ®, 30 mg, once daily) versus dupilumab (DUPIXENT® , 300 mg, every other week), which included findings published in JAMA Dermatology.

In an interview with HCPLive, Dr. Andrew Blauvelt, MD, MBA, lead investigator for the Heads Up study and president of Oregon Medical Research Center, spoke on the recent successes of the trials involving upadacitinib and dupilumab, as well as the future research surrounding both therapies.

“I want to touch on psoriasis drugs because in psoriasis drugs, (because) we've gotten better and better and better efficacy from the onset of the biologic era, and it's been almost 20 years now since the first psoriasis biologic in 2002,” Blauvelt said.

Blauvelt noted that the early data on dupilumab were promising, but they did not represent what he considered to be “great efficacy”. With phase 3b of the Heads Up study, He and fellow investigators strived for clearer skin results with upadacitinib, which were measured based on the Eczema Area and Severity Index (EASI) scoring system.

“With upadacitinib in particular, if you look at the differences in the EASI 90 and EASI 100 results, we see a greater delta between the 2 drugs than for a lower level of response EASI 75,” Blauvelt said. “So, for EASI 75 we still see differences, we still saw upadacitinib superior to dupilumab, but there were greater differences in these higher levels of clearance.”

Blauvelt considered the data found in phase 3b of the Heads Up trial to be an indicator of a “new era” in dermatology-based medicine.

Though dupilumab did not have as promising EASI results as upadacitinib, its versatility was not overlooked by Blauvelt.

Aside from dermatological therapies, dupilumab has also been shown to be effective in the management of asthma and eczema in children and young adults.

The transition from dupilumab to upadacitinib may be inevitable, though Blauvelt noted that it would not be immediate. Trials from upadacitinib are still ongoing, and adverse events such as infections and blood clots had been reported.

“The safety of (these drugs) has been better in the atopic dermatitis trials, compared to the safety of these same drugs (in patients with rheumatoid arthritis),” Blauvelt said. “In trials with rheumatoid arthritis patients where they're older, there are more concomitant medications like prednisone and methotrexate. So, in my experience, they've been pretty safe. You just have to be aware of more issues with those drugs.”

Listen to more of Dr. Blauvelt’s insights on the trials in the video above.