Real-world effectiveness and safety of Janus kinase 1 inhibitors for the treatment of moderate-to-severe atopic dermatitis: a single-center, prospective study in China
image: Fig 1
Credit: Yihui Chen, Qiaozhi Cao, Cong Peng, Bingjing Zhou, Yu Jiang, Xiang Chen, Jie Li
In China, the real-world effectiveness and safety of Janus kinase 1 (JAK1) inhibitors for moderate-to-severe atopic dermatitis (AD) are of significant interest due to the approval of upadacitinib and abrocitinib in the country. Despite their demonstrated efficacy in clinical trials, there is a scarcity of real-world data, particularly pertaining to Asian demographics. Addressing this gap, a single-center, 24-week prospective study was undertaken at Xiangya Hospital to evaluate the practical application of abrocitinib and upadacitinib in a Chinese cohort of AD patients.
The study enrolled ninety patients with moderate-to-severe AD, all of whom had either an inadequate response to conventional systemic therapies, contraindications, or had experienced adverse events related to previous systemic treatments. Patients were treated with either oral abrocitinib (100 mg once daily) or upadacitinib (15 mg once daily) and were allowed to continue the use of emollients and certain topical medications. The patients' demographic and clinical characteristics were assessed at the baseline, and disease severity along with quality of life scores were recorded at multiple intervals over the 24-week period post-treatment initiation.
The study results indicated that both abrocitinib and upadacitinib led to significant improvements in patients' conditions, with notable reductions in disease severity and pruritus as early as Week 2, which were sustained through Week 24. The improvement was measured using various indices including Eczema Area and Severity Index (EASI), Investigator’s Global Assessment (IGA), Scoring Atopic Dermatitis (SCORAD), Dermatology Life Quality Index (DLQI), Children’s DLQI (CDLQI), Peak Pruritus Numerical Rating Scale (PP-NRS), and Patient-oriented Eczema Measure (POEM). Additionally, there was a considerable decrease in total serum immunoglobulin (Ig) E and total eosinophil count (TEC) from the baseline at Week 4 in both treatment groups.
In terms of safety, both treatments were well-tolerated, with the most common adverse event being acne, occurring in 11.76% of abrocitinib-treated patients and 15.38% of upadacitinib-treated patients. No serious adverse events were reported, and there were no discontinuations or deaths due to adverse events during the 24-week treatment period.
The findings from this study align with previous clinical trials, reinforcing the favorable efficacy and safety profiles of abrocitinib and upadacitinib. However, the study acknowledges several limitations, including its single-center nature, limited sample size, and the short 24-week follow-up period. Additionally, the study only utilized low doses of the JAK1 inhibitors, and there was a significant age distribution difference between the two treatment groups, which may affect the comparability of the results. Despite these limitations, the study provides valuable real-world insights into the use of JAK1 inhibitors for AD in a Chinese population and suggests that the sustained efficacy and safety of these treatments warrant further investigation in larger, multi-center studies with longer follow-up periods and diverse patient demographics.
The study's results contribute to the clinical guidance on the use of JAK1 inhibitors for AD, offering reassurance about their real-world effectiveness and safety in a Chinese patient cohort. This information is crucial for clinicians considering these treatments and for patients seeking effective management of moderate-to-severe AD. Moving forward, the call for long-term, large-scale studies with diverse patient populations will help to further elucidate the broader implications and potential of JAK1 inhibitors in AD treatment.
In China, the real-world effectiveness and safety of Janus kinase 1 (JAK1) inhibitors for moderate-to-severe atopic dermatitis (AD) are of significant interest due to the approval of upadacitinib and abrocitinib in the country. Despite their demonstrated efficacy in clinical trials, there is a scarcity of real-world data, particularly pertaining to Asian demographics. Addressing this gap, a single-center, 24-week prospective study was undertaken at Xiangya Hospital to evaluate the practical application of abrocitinib and upadacitinib in a Chinese cohort of AD patients.
The study enrolled ninety patients with moderate-to-severe AD, all of whom had either an inadequate response to conventional systemic therapies, contraindications, or had experienced adverse events related to previous systemic treatments. Patients were treated with either oral abrocitinib (100 mg once daily) or upadacitinib (15 mg once daily) and were allowed to continue the use of emollients and certain topical medications. The patients' demographic and clinical characteristics were assessed at the baseline, and disease severity along with quality of life scores were recorded at multiple intervals over the 24-week period post-treatment initiation.
The study results indicated that both abrocitinib and upadacitinib led to significant improvements in patients' conditions, with notable reductions in disease severity and pruritus as early as Week 2, which were sustained through Week 24. The improvement was measured using various indices including Eczema Area and Severity Index (EASI), Investigator’s Global Assessment (IGA), Scoring Atopic Dermatitis (SCORAD), Dermatology Life Quality Index (DLQI), Children’s DLQI (CDLQI), Peak Pruritus Numerical Rating Scale (PP-NRS), and Patient-oriented Eczema Measure (POEM). Additionally, there was a considerable decrease in total serum immunoglobulin (Ig) E and total eosinophil count (TEC) from the baseline at Week 4 in both treatment groups.
In terms of safety, both treatments were well-tolerated, with the most common adverse event being acne, occurring in 11.76% of abrocitinib-treated patients and 15.38% of upadacitinib-treated patients. No serious adverse events were reported, and there were no discontinuations or deaths due to adverse events during the 24-week treatment period.
The findings from this study align with previous clinical trials, reinforcing the favorable efficacy and safety profiles of abrocitinib and upadacitinib. However, the study acknowledges several limitations, including its single-center nature, limited sample size, and the short 24-week follow-up period. Additionally, the study only utilized low doses of the JAK1 inhibitors, and there was a significant age distribution difference between the two treatment groups, which may affect the comparability of the results. Despite these limitations, the study provides valuable real-world insights into the use of JAK1 inhibitors for AD in a Chinese population and suggests that the sustained efficacy and safety of these treatments warrant further investigation in larger, multi-center studies with longer follow-up periods and diverse patient demographics.
The study's results contribute to the clinical guidance on the use of JAK1 inhibitors for AD, offering reassurance about their real-world effectiveness and safety in a Chinese patient cohort. This information is crucial for clinicians considering these treatments and for patients seeking effective management of moderate-to-severe AD. Moving forward, the call for long-term, large-scale studies with diverse patient populations will help to further elucidate the broader implications and potential of JAK1 inhibitors in AD treatment.