Upadacitinib for Atopic Dermatitis

From 1 February 2022, upadacitinib is available on the Pharmaceutical Benefits Scheme (PBS) to treat severe atopic dermatitis. Upadacitinib is also PBS listed for the treatment of rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis.

Upadacitinib is an inhibitor of Janus kinase (JAK), a family of enzymes involved in a range of inflammatory and immune responses. Upadacitinib is selective for JAK1, the isoform thought to be involved in many of the signs and symptoms of atopic dermatitis. Compared to less selective JAK inhibitors, this may improve efficacy and reduce adverse effects such as anaemia and thrombocytopenia.

The efficacy of upadacitinib monotherapy was assessed in the MEASURE UP studies. Patients were randomly assigned to receive upadacitinib 15mg or 30mg daily or placebo. At week 16, a higher proportion of patients in the treatment groups achieved a 75% reduction from baseline in the Eczema Area and Severity Index (EASI-75) compared to placebo (70%, 80% and 16% in the upadacitinib 15mg, upadacitinib 30mg and placebo groups, respectively).

Upadacitinib is associated with an increased risk of infections, including upper respiratory tract infections, herpes reactivation, and opportunistic infections. Therapy should be avoided in patients with an active, serious infection. The risks and benefits of upadacitinib should also be considered in patients with chronic or recurrent infection, a history of a serious or opportunistic infection, tuberculosis exposure, or conditions that predispose to infection.