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Thyssen JP, Thaçi D, Bieber T, Gooderham M, de Bruin-Weller M, Soong W, Kabashima K, Barbarot S, Luna PC, Xu J, Hu X, Liu Y, Raymundo EM, Calimlim BM, Nduaka C, Gamelli A, Simpson EL. Upadacitinib for moderate-to-severe atopic dermatitis: Stratified analysis from three randomized phase 3 trials by key baseline characteristics. J Eur Acad Dermatol Venereol 2023; 37:1871-1880. [PMID: 37247226 DOI: 10.1111/jdv.19232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/03/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is a heterogeneous inflammatory skin disease with different clinical phenotypes based on factors such as age, race, comorbidities, and clinical signs and symptoms. The effect of these factors on therapeutic responses in AD has only been scarcely studied and not for upadacitinib. Currently, there is no biomarker predicting response to upadacitinib. OBJECTIVES Evaluate the efficacy of the oral Janus kinase inhibitor upadacitinib across patient subgroups (baseline demographics, disease characteristics and prior treatment) in patients with moderate-to-severe AD. METHODS Data from phase 3 studies (Measure Up 1, Measure Up 2 and AD Up) were utilized for this post hoc analysis. Adults and adolescents with moderate-to-severe AD were randomized to receive once daily oral upadacitinib 15 mg, upadacitinib 30 mg or placebo; patients enrolled in the AD Up study received concomitant topical corticosteroids. Data from the Measure Up 1 and Measure Up 2 studies were integrated. RESULTS A total of 2584 patients were randomized. A consistently greater proportion of patients achieved at least 75% improvement in the Eczema Area and Severity Index, a 0 or 1 on the validated Investigator Global Assessment for Atopic Dermatitis, and improvement in itch (including an achievement of a reduction of ≥4; and score of 0/1 in Worst Pruritus Numerical Rating Scale) with upadacitinib compared with placebo at Week 16, regardless of age, sex, race, body mass index, AD severity, body surface area involvement, history of atopic comorbidities or asthma, or previous exposure to systemic therapy or cyclosporin. CONCLUSIONS Upadacitinib had consistently high skin clearance rates and itch efficacy across subgroups of patients with moderate-to-severe AD through Week 16. These results support upadacitinib as a suitable treatment option in a variety of patients. TRIAL REGISTRATION ClinicalTrials.gov Identifiers: NCT03569293 (Measure Up 1), NCT03607422 (Measure Up 2) and NCT03568318 (AD Up).
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Affiliation(s)
- J P Thyssen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - D Thaçi
- Institute and Comprehensive Center Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - T Bieber
- Department of Dermatology and Allergy, University Hospital of Bonn, Bonn, Germany
- Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - M Gooderham
- SKiN Centre for Dermatology, Probity Medical Research and Queen's University, Peterborough, Ontario, Canada
| | - M de Bruin-Weller
- National Expertise Center of Atopic Dermatitis, Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W Soong
- AllerVie Health - Alabama Allergy & Asthma Center and Clinical Research Center of Alabama, Birmingham, Alabama, USA
| | - K Kabashima
- Department of Dermatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - S Barbarot
- Department of Dermatology, Nantes Université, CHU Nantes, Nantes, France
| | - P C Luna
- Servicio de Dermatología, Hospital Alemán, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - J Xu
- Huashan Hospital, Fudan University, Shanghai, China
| | - X Hu
- AbbVie Inc., North Chicago, Illinois, USA
| | - Y Liu
- AbbVie Inc., North Chicago, Illinois, USA
| | | | | | - C Nduaka
- AbbVie Inc., North Chicago, Illinois, USA
| | - A Gamelli
- AbbVie Inc., North Chicago, Illinois, USA
| | - E L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon, USA
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Simpson EL, Rahawi K, Hu X, Chu AD, Nduaka C, Jazayeri S, Lio P, Lynde C, Schuttelaar MLA. Effect of upadacitinib on atopic hand eczema in patients with moderate-to-severe atopic dermatitis: Results from two randomized phase 3 trials. J Eur Acad Dermatol Venereol 2023; 37:1863-1870. [PMID: 37184290 DOI: 10.1111/jdv.19194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/18/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Approximately 60% of patients with atopic dermatitis have involvement of the hands adding to the burden of disease. OBJECTIVE This analysis aims to evaluate the effect of upadacitinib monotherapy on atopic hand eczema in patients with moderate-to-severe AD over 16 weeks in the Measure Up 1 and 2 studies. METHODS Data from patients (ages 12-75) randomized 1:1:1 to receive upadacitinib 15 mg, 30 mg, or placebo once daily in the Measure Up 1 and 2 studies were analysed for impact on atopic hand eczema assessed using the Hand Eczema Severity Index (HECSI). The percent change from baseline in HECSI score was a prespecified additional endpoint at all visits. The proportion of patients with at least a 75% improvement in HECSI score (HECSI 75) was evaluated post hoc. RESULTS Patients treated with upadacitinib 15 mg or 30 mg experienced greater improvement in HECSI score compared with placebo as early as Week 1, which was maintained through Week 16. At Week 16, the mean change from baseline in HECSI score for patients receiving upadacitinib 15 mg, 30 mg, and placebo was -68%, -74%, and -15% in Measure Up 1 and -68%, -74% and +21% (positive change indicates worsening for placebo) in Measure Up 2, respectively. A greater proportion of upadacitinib-treated patients achieved HECSI 75 compared with placebo at all timepoints beginning at Week 1 through Week 16. CONCLUSIONS Upadacitinib 15 mg and 30 mg monotherapy provided rapid and sustained improvement in atopic hand eczema compared with placebo through Week 16 in patients with moderate-to-severe AD. At Week 16, the observed mean improvements in HECSI score in upadacitinib-treated patients were clinically meaningful based on previous interpretability studies. These results suggest that upadacitinib may be an effective treatment option for atopic hand eczema in patients with moderate-to-severe AD.
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Affiliation(s)
- E L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon, USA
| | - K Rahawi
- AbbVie, Inc, North Chicago, Illinois, USA
| | - X Hu
- AbbVie, Inc, North Chicago, Illinois, USA
| | - A D Chu
- AbbVie, Inc, North Chicago, Illinois, USA
| | - C Nduaka
- AbbVie, Inc, North Chicago, Illinois, USA
| | - S Jazayeri
- Alliance Dermatology and Mohs Center PC, Phoenix, Arizona, USA
| | - P Lio
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - C Lynde
- Lynde Institute of Dermatology and Probity Medical Research, Markham, Ontario, Canada
| | - M L A Schuttelaar
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Lamba M, Hutmacher MM, Furst DE, Dikranian A, Dowty ME, Conrado D, Stock T, Nduaka C, Cook J, Krishnaswami S. Model-Informed Development and Registration of a Once-Daily Regimen of Extended-Release Tofacitinib. Clin Pharmacol Ther 2017; 101:745-753. [PMID: 27859030 PMCID: PMC5485720 DOI: 10.1002/cpt.576] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/21/2016] [Accepted: 11/09/2016] [Indexed: 12/13/2022]
Abstract
Extended‐release (XR) formulations enable less frequent dosing vs. conventional (e.g., immediate release (IR)) formulations. Regulatory registration of such formulations typically requires pharmacokinetic (PK) and clinical efficacy data. Here we illustrate a model‐informed, exposure–response (E‐R) approach to translate controlled trial data from one formulation to another without a phase III trial, using a tofacitinib case study. Tofacitinib is an oral Janus kinase (JAK) inhibitor for the treatment of rheumatoid arthritis (RA). E‐R analyses were conducted using validated clinical endpoints from phase II dose–response and nonclinical dose fractionation studies of the IR formulation. Consistent with the delay in clinical response dynamics relative to PK, average concentration was established as the relevant PK parameter for tofacitinib efficacy and supported pharmacodynamic similarity. These evaluations, alongside demonstrated equivalence in total systemic exposure between IR and XR formulations, provided the basis for the regulatory approval of tofacitinib XR once daily by the US Food and Drug Administration.
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Affiliation(s)
- M Lamba
- Pfizer Inc, Groton, Connecticut, USA
| | - M M Hutmacher
- Ann Arbor Pharmacometrics Group, Ann Arbor, Michigan, USA
| | - D E Furst
- University of California, Los Angeles, California, USA
| | - A Dikranian
- San Diego Arthritis Medical Clinic, San Diego, California, USA
| | - M E Dowty
- Pfizer Inc, Cambridge, Massachusetts, USA
| | - D Conrado
- Pfizer Inc, Groton, Connecticut, USA
| | - T Stock
- Pfizer Inc, Collegeville, Pennsylvania, USA
| | - C Nduaka
- Pfizer Inc, Collegeville, Pennsylvania, USA
| | - J Cook
- Pfizer Inc, Groton, Connecticut, USA
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Winthrop K, Wouters A, Choy E, Soma K, Hodge J, Nduaka C, Biswas P, McNeil L, Passador S, Mojcik C, Rigby W. FRI0110 Assessment of Immunogenicity of Live Zoster Vaccination in Rheumatoid Arthritis Patients on Background Methotrexate before and after Initiating Tofacitinib or Placebo. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lamba M, Furst D, Dikranian A, Dowty M, Hutmacher M, Conrado D, Stock T, Nduaka C, Krishnaswami S. THU0192 Evaluating Pharmacokinetic Predictors of Tofacitinib Clinical Response in Rheumatoid Arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Wollenhaupt J, Silverfield J, Lee E, Terry K, Kwok K, Lazariciu I, Nduaka C, Connell C, DeMasi R, Wang L. THU0185 Tofacitinib, An Oral JAK Inhibitor, in The Treatment of Rheumatoid Arthritis: Safety and Clinical and Radiographic Efficacy in Open-Label, Long-Term Extension Studies over 7 Years. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Wollenhaupt J, Silverfield J, Lee E, Wood S, Terry K, Nakamura H, Kwok K, Anisfeld A, Nduaka C, Wang L. THU0179 Tofacitinib, an Oral Janus Kinase Inhibitor, for the Treatment of Rheumatoid Arthritis: Safety and Efficacy in Open-label, Long-term Extension up to 6 Years. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Curtis J, Lee E, Martin G, Mariette X, Terry K, Chen Y, Geier J, Andrews J, Kaur M, Fan H, Nduaka C. THU0174 Analysis of Non-melanoma Skin Cancer Across the Tofacitinib Rheumatoid Arthritis Clinical Programme. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Strand V, Isaacs J, Beal J, Nduaka C, Krishnaswami S, Riese R, Boy M, Menon S. THU0145 Association of Mean Changes in Laboratory Safety Parameters with C-Reactive Protein at Baseline and Week 12 in Rheumatoid Arthritis Patients Treated with Tofacitinib. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Isaacs J, Nduaka C, Zuckerman A, Krishnaswami S, Riese R, Lan S, Hutmacher M, Boy M, Bradley J. AB0595 Changes in serum creatinine in patients with active rheumatoid arthritis treated with TOFACITINIB (CP-690,550). Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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