AbbVie’s RINVOQ (upadacitinib) performed well in Measure Up 1, the first Phase 3 study to evaluate its efficacy and safety for the treatment of moderate-to-severe atopic dermatitis.
Full results from Measure Up 1 will be presented at a future medical meeting and published in a peer-reviewed publication. Use of RINVOQ in atopic dermatitis is not approved and its safety and efficacy have not been evaluated by regulatory authorities.
Upadacitinib met its co-primary endpoints of at least a 75 percent improvement in the Eczema Area Severity Index (EASI 75) and a validated Investigator's Global Assessment for Atopic Dermatitis (vIGA-AD) of clear or almost clear (0/1) at week 16 in adults and adolescents with moderate to severe atopic dermatitis who are candidates for systemic therapy.
In this study, patients receiving either 15 mg or 30 mg of upadacitinib monotherapy showed significant improvement in skin clearance. Of patients receiving upadacitinib 15/30 mg, 70/80 percent achieved EASI 75 at week 16, respectively, versus 16 percent in the placebo group (p<0.001). Of those treated with upadacitinib 15/30 mg, 48/62 percent of patients achieved vIGA-AD 0/1, respectively, versus 8 percent of patients receiving placebo (p<0.001), the study showed.
"People with atopic dermatitis often struggle with relentless skin and itch symptoms, resulting in a significant unmet need," says Michael Severino, M.D., vice chairman and president, AbbVie, in a news release. "We're excited by these results, which show the potential of RINVOQ for individuals living with the burden of atopic dermatitis."
For both doses, patients experienced an early reduction in itch, which was maintained through week 16. Clinically meaningful reduction in itch was defined as improvement in Worst Pruritus Numerical Rating Scale (NRS)≥4, which was achieved by a significantly higher proportion of patients receiving upadacitinib 15/30 mg at week 16 compared to placebo (52/60 percent, respectively, versus 12 percent, p<0.001). Clinically meaningful reductions in itch compared to placebo were observed as early as one day after the first dose (day 2) for patients receiving upadacitinib 30 mg (12 percent versus 4 percent, p<0.001) and two days after the first dose (day 3) for patients receiving upadacitinib 15 mg (16 percent versus 3 percent, p<0.001).
"Both adolescents and adults patients living with moderate to severe atopic dermatitis often suffer from an enormous burden of disease that can affect every aspect of their daily life," says lead investigator Emma Guttman-Yassky, M.D., Ph.D., professor of dermatology and immunology, Icahn School of Medicine at Mount Sinai Medical Center in New York City. "It is encouraging to see the high proportion of patients achieving clear or almost clear skin with upadacitinib, and the meaningful and rapid reduction in itch with both doses."
No new safety risks were observed compared to the safety profile observed in patients with rheumatoid arthritis and psoriatic arthritis receiving RINVOQ. In Measure Up 1, serious adverse events occurred in 2.1 percent of patients receiving upadacitinib 15 mg, 2.8 percent of patients receiving upadacitinib 30 mg, and 2.8 percent of patients receiving placebo at week 16. The most common treatment-emergent adverse events were acne, upper respiratory tract infection and nasopharyngitis. Acne was observed with both doses of upadacitinib (6.8 percent of patients on 15 mg and 17.2 percent of patients on 30 mg) versus placebo (2.1 percent of patients) and was mild to moderate in most cases.1 Eczema herpeticum was observed in patients receiving upadacitinib 30 mg (1.1 percent of patients) and placebo (1.4 percent of patients); it was not observed in patients receiving upadacitinib 15 mg.1 Serious infections were reported infrequently (0.7 percent of patients receiving upadacitinib 15 mg or 30 mg; none were observed on placebo). No deaths, venous thromboembolic events (VTE) or major adverse cardiac events (MACE) were reported.
RINVOQ is an oral, once-daily, selective and reversible JAK inhibitor studied in several immune-mediated inflammatory diseases. It was engineered to have greater inhibitory potency for JAK1 versus JAK2, JAK3 and TYK2. In August 2019, RINVOQ received U.S. Food and Drug Administration approval for adult patients with moderately to severely active rheumatoid arthritis who have had an inadequate response or intolerance to methotrexate. In December 2019, RINVOQ also received approval by the European Commission for the treatment of adult patients with moderate to severe active rheumatoid arthritis who have responded inadequately to, or who are intolerant to one or more disease-modifying anti-rheumatic drugs. The approved dose for RINVOQ in rheumatoid arthritis is 15 mg. Phase 3 trials of RINVOQ in atopic dermatitis, rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, Crohn's disease, ulcerative colitis and giant cell arteritis are ongoing.
More About the Measure Up 1 Study
Measure Up 1 is a Phase 3, multicenter, randomized, double-blind, parallel-group, placebo-controlled study designed to evaluate the safety and efficacy of upadacitinib in adult and adolescent (12 years or older) patients with moderate to severe atopic dermatitis who are candidates for systemic treatment. Patients were randomized to upadacitinib 15 mg, upadacitinib 30 mg or placebo, followed by either upadacitinib 15 mg or upadacitinib 30 mg at week 16.
The co-primary endpoints were the percentage of patients achieving EASI 75 and a vIGA score of 0/1 after 16 weeks of treatment. Secondary endpoints included Improvement in Worst Pruritus NRS≥4 at week 16, EASI 90, percent change in Worst Pruritus NRS, percent change in EASI at week 16, as well as improvement in Worst Pruritus NRS≥4 at day 2 (one day after the first dose) for patients receiving upadacitinib 30 mg and improvement in Worst Pruritus NRS≥4 at day 3 (two days after the first dose) for patients receiving upadacitinib 15 mg. The trial is ongoing, and the long-term extension period remains blinded to investigators and patients, to evaluate the long-term safety, tolerability and efficacy of the two once-daily doses (15 mg and 30 mg) of upadacitinib in patients who have completed the placebo-controlled period.