LEVEL UP: Switching from Dupilumab to Upadacitinib Promising for AD Patients
New research presented at the 44th Annual Fall Clinical Dermatology Conference offered compelling results from the LEVEL UP study, a clinical trial examining outcomes for patients with moderate-to-severe atopic dermatitis (AD) who switched from dupilumab (DUPI) to upadacitinib (UPA) after showing insufficient response to the former.
"Switching from Dupilumab to Upadacitinib in Adults and Adolescents with Moderate-to-Severe Atopic Dermatitis and Inadequate Response to Dupilumab: Efficacy and Safety Results from the Phase 3b/4 LEVEL UP Study" was presented by Drs. Christopher G. Bunick, Nina Magnolo, Angela Moore, Gao Xinghua, Charles Lynde, Nadia Ibrahim, Ayman Grada, Gweneth Levy, Brian Calimlim, Xiaoqiang Wu, Yolanda Armendariz, and Kilian Eyerich.
Researchers for the LEVEL UP study enrolled 355 patients with moderate-to-severe AD who had not responded adequately to DUPI or had contraindications to systemic therapies. Among these, 208 patients transitioned from DUPI to UPA in the second part of the trial. At 16 weeks after the switch (Week 32), 79.6% of those patients achieved a 75% improvement in their Eczema Area and Severity Index (EASI 75), 58.7% reached EASI 90, and 19.9% achieved full skin clearance (EASI 100).
Patients experienced relief as soon as four weeks after switching (Week 20). Itch reduction also improved significantly; many patients reported at least a 4-point decrease in their Worst Pruritus Numerical Rating Scale (WP-NRS) scores by Week 32, and 26.8% of patients achieved both near-complete skin clearance (EASI 90) and a WP-NRS score of 0 or 1.
Safety profiles for UPA remained favorable, with treatment-emergent adverse events, including mild respiratory infections and acne, appearing in similar rates in both the switch group and patients who continued UPA treatment. No severe complications (such as malignancies or cardiac events) were reported in either group, and no patients discontinued treatment due to infections like mild eczema herpeticum.
The findings, according to the authors, suggest UPA could be an effective next step for AD patients who do not achieve desired outcomes on DUPI, offering an improvement in overall quality of life through significant skin improvement and itch reduction.
-
Disclosures
AbbVie and the authors thank the participants, study sites, and investigators who participated in this clinical trial. AbbVie funded this trial and participated in the trial design, research, analysis, data collection, interpretation of data, and the review and approval of the publication. All authors had access to relevant data and participated in the drafting, review, and approval of this publication. No honoraria or payments were made for authorship. Medical writing support was provided by Elin M Grissom, PhD of AbbVie.
Financial arrangements of the authors with companies whose products may be related to the present report are listed as declared by the authors: CG Bunick has served as an investigator for AbbVie, Almirall, Apogee, Daiichi Sankyo, LEO Pharma, Ortho Dermatologics, Sun Pharma, Timber, and Palvella; a consultant for AbbVie, Almirall, Apogee, Arcutis, Connect BioPharma, Eli Lilly, EPI Health/Novan, Incyte, LEO Pharma, Novartis, Ortho Dermatologics, Pfizer, Sanofi-Regeneron, Takeda, and UCB; and a speaker for and received honoraria from Allergan, Almirall, LEO Pharma, and UCB. N Magnolo has received honoraria for participation on advisory boards, as a speaker and/or for consultancy from AbbVie, Almirall, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Janssen, LEO Pharma, Novartis, Pfizer, Sanofi, and UCB Pharma. A Moore has received honoraria or research funds from Abbvie, Aclaris, Acrotech, Arcutis, Bayer, Cara, Eli Lilly, Galderma, Incyte, Pfizer, Rapt, and Sanofi-Regeneron. G Xinghua has served as speaker for Eli Lilly, GSK, Janssen, LEO Pharma, Novartis, Pfizer, Pierre Fabre, Regeneron Pharmaceuticals Inc., Sanofi and, consultancy/advisory board member for AbbVie, Boehringer Ingelheim, Novartis, Pfizer, Sanofi – investigator; AbbVie, AstraZeneca, BMS, Eli Lilly, Huarun, JiaLan, LEO Pharma, Pfizer, Puqi and Sanofi. C Lynde has acted as a principal investigator, speaker and/or consultant for AbbVie, Amgen AnatpysBio, Avillon, Arcutis, Bristol-Myers Squibb, Celgene Cipher Genentech, GlenMark, Incyte, Janssen, Leo Pharma, Kyowa, Pfizer, and Merck. N Ibrahim, A Grada, G Levy, B Calimlim, X Wu, Y Armendariz are full-time employees of AbbVie Inc and may hold AbbVie stock and/or stock options. K Eyerich has received grants and personal fees from AbbVie; has received personal fees from Almirall, Bristol Myers Squibb, LEO Pharma, Lilly, Janssen, Novartis, UCB, and Sanofi; and has received grants from Lilly, LEO Pharma, Janssen, Novartis, and UCB.