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Efficacy and safety of abrocitinib for the treatment of adolescents and adults with moderate-to-severe atopic dermatitis: update of a living systematic review and meta-analysis

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  • Published:
European Journal of Dermatology

Abstract

Background

Despite extensive research on biological therapies for atopic dermatitis (AD), recent clinical trials of the Janus kinase inhibitor 1, abrocitinib, have provided more definitive evidence regarding its efficacy and safety in treating AD.

Objectives

To conduct a living systematic review and meta-analysis to evaluate the efficacy and safety of abrocitinib in adolescents and adults with moderate-to-severe AD.

Materials & Methods

The databases of PubMed, Embase, Cochrane Library and clinical trial registries were searched from inception of the databases to July 11, 2023. Only randomized controlled trials assessing the efficacy and safety of abrocitinib in individuals with moderate-to-severe AD were included in the meta-analysis.

Results

Twelve studies involving a total of 5,644 participants aged 12 years or older were included in the analysis. The pooled results revealed a significantly higher proportion of patients achieving Investigator Global Assessment response (RR = 3.52, 95% CI: 2.78 to 4.46), Eczema Area and Severity Index response (RR = 3.35, 95% CI: 2.54 to 4.41), Peak Pruritus Numeric Rating Scale response (RR = 2.54, 95% CI: 1.95 to 3.30), and Patient-Oriented Eczema Measure response (abrocitinib 100-mg group: −4.25, 95% CrI: −5.24 to −3.27; abrocitinib 200-mg group: −7.69, 95% CrI: −8.39 to −6.99) compared to the placebo group. Additionally, there was no significant differences in adverse events between the abrocitinib and placebo groups.

Conclusion

Abrocitinib demonstrates a favourable safety profile and robust efficacy in treating moderate-to-severe AD compared to placebo. The 200-mg dose regimen appears to be more effective than the 100-mg dose regimen for the treatment of AD.

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Data availability: All the data supporting the results of this study are available from the corresponding author upon request.

References

  1. Langan SM, Irvine AD, Weidinger S. Atopic dermatitis. Lancet 2020; 396: 345–60.

    Article  CAS  PubMed  Google Scholar 

  2. Pezzolo E, Naldi L. Epidemiology of major chronic inflammatory immune-related skin diseases in 2019. Expert Rev Clin Immunol 2020; 16: 155–66.

    Article  CAS  PubMed  Google Scholar 

  3. Ring J, Zink A, Arents BWM, et al. Atopic eczema: burden of disease and individual suffering-results from a large EU study in adults. J Eur Acad Dermatol Venereol 2019; 33: 1331–40.

    Article  CAS  PubMed  Google Scholar 

  4. Kim JE, Kim HS. Microbiome of the skin and gut in atopic dermatitis (ad): understanding the pathophysiology and finding novel management strategies. J Clin Med 2019; 8.

  5. Werfel T, Biedermann T. Current novel approaches in systemic therapy of atopic dermatitis: specific inhibition of cutaneous Th2 polarized inflammation and itch. Curr Opin Allergy Clin Immunol 2015; 15: 446–52.

    Article  CAS  PubMed  Google Scholar 

  6. Wollenberg A, Barbarot S, Bieber T, et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part II. J Eur Acad Dermatol Venereol 2018; 32: 850–78.

    Article  CAS  PubMed  Google Scholar 

  7. Simpson EL, Bieber T, Guttman-Yassky E, et al. Two phase 3 trials of dupilumab versus placebo in atopic dermatitis. N Engl J Med 2016; 375: 2335–48.

    Article  CAS  PubMed  Google Scholar 

  8. Simpson, EL, Merola JF, Silverberg J, et al. Safety of tralokinumab in adult patients with moderate-to-severe atopic dermatitis: pooled analysis of five randomized, double-blind, placebo-controlled phase II and phase III trials. Br J Dermatol 2022; 187: 888–99.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Popovic B, Breed J, Rees DG, et al. Structural characterisation reveals mechanism of IL-13-neutralising monoclonal antibody tralokinumab as inhibition of binding to IL-13Ra1 and IL-13Ra2. J Mol Biol 2017; 429: 208–19.

    Article  CAS  PubMed  Google Scholar 

  10. Damsky W, Peterson D, Ramseier J, et al. The emerging role of Janus kinase inhibitors in the treatment of autoimmune and inflammatory diseases. J Allergy Clin Immunol 2021; 147: 814–26.

    Article  CAS  PubMed  Google Scholar 

  11. Damsky W, King BA. JAK inhibitors in dermatology: the promise of a new drug class. J Am Acad Dermatol 2017; 76: 736–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Darnell JE, Kerr IM, Stark GR. Jak-STAT pathways and transcriptional activation in response to IFNs and other extracellular signaling proteins. Science 1994; 264: 1415–21.

    Article  CAS  PubMed  Google Scholar 

  13. Shreberk-Hassidim R, Ramot Y, Zlotogorski A. Janus kinase inhibitors in dermatology: a systematic review. J Am Acad Dermatol 2017; 76: 745–53 e719.

    Article  CAS  PubMed  Google Scholar 

  14. Zheng C, Tosti A. Alopecia areata: new treatment options including janus kinase inhibitors. Dermatol Clin 2021; 39: 407–15.

    Article  CAS  PubMed  Google Scholar 

  15. Spinelli FR, Meylan F, O’Shea JJ, et al. JAK inhibitors: ten years after. Eur J Immunol 2021; 51: 1615–27.

    Article  CAS  PubMed  Google Scholar 

  16. Jo CE, Gooderham M, Beecker J. TYK 2 inhibitors for the treatment of dermatologic conditions: the evolution of JAK inhibitors. Int J Dermatol 2022; 61: 139–47.

    Article  CAS  PubMed  Google Scholar 

  17. Miklossy G, Hilliard TS, Turkson J. Therapeutic modulators of STAT signalling for human diseases. Nat Rev Drug Discov 2013; 12: 611–29.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Bissonnette R, Papp KA, Poulin Y, et al. Topical tofacitinib for atopic dermatitis: a phase IIa randomized trial. Br J Dermatol 2016; 175: 902–11.

    Article  CAS  PubMed  Google Scholar 

  19. Bokhari L, Sinclair R. Treatment of alopecia universalis with topical Janus kinase inhibitors-a double blind, placebo, and active controlled pilot study. Int J Dermatol 2018; 57: 1464–70.

    Article  CAS  PubMed  Google Scholar 

  20. Simpson EL, Lacour JP, Spelman L, et al. Baricitinib in patients with moderate-to-severe atopic dermatitis and inadequate response to topical corticosteroids: results from two randomized monotherapy phase III trials. Br J Dermatol 2020; 183: 242–55.

    Article  CAS  PubMed  Google Scholar 

  21. Reich K, DeLozier AM, Nunes FP, et al. Baricitinib improves symptoms in patients with moderate-to-severe atopic dermatitis and inadequate response to topical corticosteroids: patient-reported outcomes from two randomized monotherapy phase III trials. J Dermatolog Treat 2022; 33: 1521–30.

    Article  CAS  PubMed  Google Scholar 

  22. Vazquez ML, Kaila N, et al. Identification of N-{cis-3-[Methyl(7H-pyrrolo[2,3-d]pyrimidin-4-yl)amino]cyclobutyl}propane-1-sulfonamide (PF-04965842): a selective JAK1 clinical candidate for the treatment of autoimmune diseases. J Med Chem 2018; 61: 1130–52.

    Article  CAS  PubMed  Google Scholar 

  23. Howell MD, Kuo FI, Smith PA. Targeting the Janus kinase family in autoimmune skin diseases. Front Immunol 2019; 10: 2342.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Szilveszter KP, Németh T, Mócsai A. Tyrosine kinases in autoimmune and inflammatory skin diseases. Front Immunol 2019; 10: 1862.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Bieber T, Simpson EL, Silverberg JI, et al. Abrocitinib versus placebo or dupilumab for atopic dermatitis. New Engl J Med 2021; 384: 1101–12.

    Article  CAS  PubMed  Google Scholar 

  26. Blauvelt A, Silverberg JI, Lynde CW, et al. Abrocitinib induction, randomized withdrawal, and retreatment in patients with moderate-to-severe atopic dermatitis: results from the JAK1 Atopic Dermatitis Efficacy and Safety (JADE) REGIMEN phase 3 trial. J Am Acad Dermatol 2022; 86: 104–12.

    Article  CAS  PubMed  Google Scholar 

  27. Cork MJ, McMichael A, Teng J, et al. Impact of oral abrocitinib on signs, symptoms and quality of life among adolescents with moderate-to-severe atopic dermatitis: an analysis of patient-reported outcomes. J Eur Acad Dermatol Venereol 2022; 36: 422–33.

    Article  CAS  PubMed  Google Scholar 

  28. Eichenfield LF, Flohr C, et al. Efficacy and safety of abrocitinib in combination with topical therapy in adolescents with moderate-to-severe atopic dermatitis: the JADE TEEN randomized clinical trial. JAMA Dermatol 2021; 157: 1165–73.

    Article  PubMed  Google Scholar 

  29. Gooderham MJ, Forman SB, et al. Efficacy and safety of oral janus kinase 1 inhibitor abrocitinib for patients with atopic dermatitis: a Phase 2 randomized clinical trial. JAMA Dermatol 2019; 155: 1371–9.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Gooderham MJ, Girolomoni G, et al. Durability of response to abrocitinib in patients with moderate-to-severe atopic dermatitis after treatment discontinuation in a phase 2b trial. Dermatol Ther (Heidelb) 2022; 12: 2077–85.

    Article  PubMed  Google Scholar 

  31. Silverberg JI, Simpson EL, et al. Efficacy and safety of abrocitinib in patients with moderate-to-severe atopic dermatitis: a randomized clinical trial. JAMA Dermatol 2020; 156: 863–73.

    Article  PubMed  Google Scholar 

  32. Silverberg JI, Thyssen JP, et al. Impact of oral abrocitinib monotherapy on patient-reported symptoms and quality of life in adolescents and adults with moderate-to-severe atopic dermatitis: a pooled analysis of patient-reported outcomes. Am J Clin Dermatol 2021; 22: 541–54.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Simpson EL, Sinclair R, Forman, S, et al. Efficacy and safety of abrocitinib in adults and adolescents with moderate-to-severe atopic dermatitis (JADE MONO-1): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial. Lancet 2020; 396: 255–66.

    Article  CAS  PubMed  Google Scholar 

  34. Simpson EL, Wollenberg A, Bissonnette R, et al. Patient-reported symptoms and disease impacts in adults with moderate-to-severe atopic dermatitis: results from a phase 2b study with abrocitinib. Dermatitis 2021; 32: S53–61.

    Article  CAS  PubMed  Google Scholar 

  35. Shi VY, Bhutani T, Fonacier L, et al. Phase 3 efficacy and safety of abrocitinib in adults with moderate-to-severe atopic dermatitis after switching from dupilumab (JADE EXTEND). J Am Acad Dermatol 2022; 87: 351–8.

    Article  CAS  PubMed  Google Scholar 

  36. Thyssen JP, Yosipovitch G, Paul C, et al. Patient-reported outcomes from the JADE COMPARE randomized phase 3 study of abrocitinib in adults with moderate-to-severe atopic dermatitis. J Eur Acad Dermatol Venereol 2022; 36: 434–43.

    Article  CAS  PubMed  Google Scholar 

  37. Meher BR, Mohanty RR, Padhy BM, et al. Efficacy and safety of abrocitinib for the treatment of moderate-to-severe atopic dermatitis: a meta-analysis of randomized clinical trials. J Dermatol Treat 2022; 33: 2335–43.

    Article  CAS  Google Scholar 

  38. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 2009; 62: 1006–12.

    Article  PubMed  Google Scholar 

  39. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for systematic reviews of interventions version 6.2 (updated February 2021). Cochrane, 2021. Available from www.training.cochrane.org/handbook.

  40. Egger M, Davey SG, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Simpson E, Bissonnette R, et al. The Validated Investigator Global Assessment for Atopic Dermatitis (vIGA-AD): the development and reliability testing of a novel clinical outcome measurement instrument for the severity of atopic dermatitis. J Am Acad Dermatol 2020; 83: 839–46.

    Article  PubMed  Google Scholar 

  42. Reich, K, Thyssen, JP, Blauvelt, A, et al. Efficacy and safety of abrocitinib versus dupilumab in adults with moderate-to-severe atopic dermatitis: a randomised, double-blind, multicentre phase 3 trial. The Lancet 2022; 400: 273–82.

    Article  CAS  Google Scholar 

  43. 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: 1047–55.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Drucker AM, Ellis AG, Bohdanowicz M, et al. Systemic immunomodulatory treatments for patients with atopic dermatitis: a systematic review and network meta-analysis. JAMA Dermatol 2020; 156: 659–67.

    Article  PubMed  Google Scholar 

  45. Drucker AM, Morra DE, Prieto-Merino, et al. Systemic immunomodulatory treatments for atopic dermatitis: update of a living systematic review and network meta-analysis. JAMA Dermatol 2022; 158: 523–32.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Singh R, Heron CE, Ghamrawi RI, et al. Emerging role of janus kinase inhibitors for the treatment of atopic dermatitis. Immunotargets Ther 2020; 9: 255–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Charles-Schoeman C, Fleischmann RM, Mysler E, et al. POS0239 risk of venous thromboembolic events in patients with rheumatoid arthritis aged≥ 50 years with ≥1 cardiovascular risk factor: results from a phase 3b/4 randomised study of tofacitinib vs tumour necrosis factor inhibitors. Ann Rheum Dis 2022; 81: 358–9. https://doi.org/10.1136/ANNRHEUMDIS-2022-EULAR.1016.

    Article  Google Scholar 

  48. European Medicines Agency (EMA). EMA recommends measures to risk of serious side effects with janus kinase inhibitors for chronic inflammatory disorders news 28/10/2022. www.ema.europa.eu/en/news/ema-recommends-measures-minimise-risk-seriousside-effects-janus-kinaseinhibitors-chronic.

  49. Elmariah SB, Smith JS, Merola JF. JAK in the [Black] box: a dermatology perspective on systemic JAK inhibitor safety. Am J Clin Dermatol 2022; 23: 427–31.

    Article  PubMed  Google Scholar 

  50. Simpson EL, Silverberg JI, Nosbaum A, et al. Integrated safety analysis of abrocitinib for the treatment of moderateto-severe atopic dermatitis from the phase II and phase III clinical trial program. Am J Clin Dermatol 2021; 22: 693–707.

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Xinjie Deng.

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Zheng, H., Chen, Y., Xu, Y. et al. Efficacy and safety of abrocitinib for the treatment of adolescents and adults with moderate-to-severe atopic dermatitis: update of a living systematic review and meta-analysis. Eur J Dermatol 33, 530–543 (2023). https://doi.org/10.1684/ejd.2023.4557

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  • DOI: https://doi.org/10.1684/ejd.2023.4557

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