Abstract
Targeted Janus kinase (JAK) 1 inhibition suppresses cytokine signaling pathways involved in the pathogenesis of atopic dermatitis. Upadacitinib is FDA approved for both adolescents and adults for the treatment of moderate to severe atopic dermatitis who have failed or have contraindications to alternative systemic treatments. Upadacitinib is available in 15 and 30 mg, once daily doses. Clinical trials have demonstrated superior clinical efficacy compared to placebo and dupilumab in producing short-term clinical response. Important considerations prior to treatment initiation with JAK inhibitors include an increased risk of serious infections, mortality, malignancy, major adverse cardiovascular events (MACEs), and thrombosis. Recommendations for baseline lab monitoring prior to starting upadacitinib include a TB evaluation, viral hepatitis panel, complete blood count (CBC), liver enzymes, and lipid panel. Blood, liver, and lipid level monitoring after treatment initiation may be considered.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Bußmann C, Novak N. Systemic therapy of atopic dermatitis. Allergol Select. 2017;1(1):1–8. https://doi.org/10.5414/ALX01285E.
Tamari M, Hirota T. Genome-wide association studies of atopic dermatitis. J Dermatol. 2014;41(3):213–20.
Gittler JK, et al. Progressive activation of T(H)2/T(H)22 cytokines and selective epidermal proteins characterizes acute and chronic atopic dermatitis. J Allergy Clin Immunol. 2012;130(6):1344–54.
Furue M, et al. Atopic dermatitis: immune deviation, barrier dysfunction, IgE autoreactivity and new therapies. Allergol Int. 2017;66(3):398–403.
Kisseleva, Bhattacharya S, Braunstein J, Schindler CW, et al. Signaling through the JAK/STAT pathway, recent advances and future challenges. Gene. 2002;285(1–2):1–24. https://doi.org/10.1016/S0378-1119(02)00398-0.
Howell MD, Kuo FI, Smith PA. Targeting the Janus kinase family in autoimmune skin diseases. Front Immunol. 2019;10:2342. https://doi.org/10.3389/fimmu.2019.02342.
Szalus K, Trzeciak M, Nowicki RJ. JAK-STAT inhibitors in atopic dermatitis from pathogenesis to clinical trials results. Microorganisms. 2020;8(11):1743. https://doi.org/10.3390/microorganisms8111743.
Guttman-Yassky E, Teixeira HD, Simpson EL, Papp KA, Pangan AL, Blauvelt A, Thaçi D, Chia-Yu Chu H, Hong C-h, Katoh N, Paller AS, Calimlim B, Yihua G, **aofei H, Liu M, Yang Y, Liu J, Tenorio AR, Chu AD, Irvine AD. Once-daily upadacitinib versus placebo in adolescents and adults with moderate-to-severe atopic dermatitis (Measure Up 1 and Measure Up 2): results from two replicate double-blind, randomised controlled phase 3 trials. Lancet. 2021;397(10290):2151–68, ISSN: 0140-6736. https://doi.org/10.1016/S0140-6736(21)00588-2.
Blauvelt A, Teixeira HD, Simpson EL, et al. Efficacy and safety of upadacitinib vs dupilumab in adults with moderate-to-severe atopic dermatitis: a randomized clinical trial. JAMA Dermatol. 2021;157(9):1047–55. https://doi.org/10.1001/jamadermatol.2021.3023.
Wan H, Jia H, **a T, Zhang D. Comparative efficacy and safety of abrocitinib, baricitinib, and upadacitinib for moderate-to-severe atopic dermatitis: A network meta-analysis. Dermatol Ther. 2022;35(9):e15636. https://doi.org/10.1111/dth.15636. Epub 2022 Jul 27.
Rinvoq. Package insert. Abbvie; 2019–2022. Updated January 2022.
Perche PO, Cook MK, Feldman SR. Abrocitinib: a new FDA-approved drug for moderate-to-severe atopic dermatitis. https://doi-org.ucsf.idm.oclc.org/101177/10600280221096713 [Internet]. 2022 [cited 2022 Dec 23];57(1):86–98. Available from: https://journals-sagepub-com.ucsf.idm.oclc.org/doi/10.1177/10600280221096713?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed
Ytterberg SR, Bhatt DL, Mikuls TR, Koch GG, Fleischmann R, Rivas JL, Germino R, Menon S, Sun Y, Wang C, Shapiro AB, Kanik KS, Connell CA, ORAL Surveillance Investigators. Cardiovascular and cancer risk with tofacitinib in rheumatoid arthritis. N Engl J Med. 2022;386(4):316–26. https://doi.org/10.1056/NEJMoa2109927.
Upadacitinib for rheumatoid arthritis. Aust Prescr 2020;43(5):178–179. doi: https://doi.org/10.18773/austprescr.2020.053. Epub 2020 Aug 6.
Nash P, Kerschbaumer A, Dörner T, et al. Points to consider for the treatment of immune-mediated inflammatory diseases with Janus kinase inhibitors: a consensus statement. Ann Rheum Dis. 2021;80:71–87.
Tsakok T, Woolf R, Smith CH, Weidinger S, Flohr C. Atopic dermatitis: the skin barrier and beyond. Br J Dermatol. 2019;180(3):464–74.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2024 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Spencer, R.K. et al. (2024). Treatment of AD with Upadacitinib. In: Brownstone, N., Liao, W., Bhutani, T. (eds) Clinical Cases in Atopic Dermatitis. Clinical Cases in Dermatology. Springer, Cham. https://doi.org/10.1007/978-3-031-52147-8_16
Download citation
DOI: https://doi.org/10.1007/978-3-031-52147-8_16
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-52146-1
Online ISBN: 978-3-031-52147-8
eBook Packages: MedicineMedicine (R0)