Experiences from daily practice of upadacitinib treatment on atopic dermatitis with a focus on hand eczema: Results from the BioDay registry

Abstract

Background: Real-world data on the effectiveness of upadacitinib on atopic dermatitis (AD), hand eczema (HE) and HE in the context of AD are limited.Objectives: To evaluate the effectiveness and safety of upadacitinib on AD and on HE in patients with AD. Methods: This prospective observational cohort study includes clinical outcomes: Eczema Area and Severity Index (EASI), Investigator's Global Assessment (IGA), Hand Eczema Severity Index (HECSI), Photographic guide; and PROMs: average pruritus and pain Numeric Rating Scale (NRS) score of the past week, Patient-Oriented Eczema Measure (POEM), Patient-Oriented Eczema, Dermatology Life Quality Index (DLQI), Atopic Dermatitis Control Tool (ADCT), Patient Global Assessment of Disease (PGAD), Quality Of Life Hand Eczema Questionnaire (QOLHEQ) at baseline, Week 4, and Week 16 of upadacitinib-treated patients. Adverse events were monitored during each visit. Results: Thirty-eight patients were included, of which 32 patients had HE. At Week 16, EASI-75 was achieved by 50.0%. Absolute cutoff score NRS-pruritus ≤4 was reached by 62.5%, POEM ≤7 by 37.5%, DLQI ≤5 by 59.4%, ADCT <7 by 68.8%, and PGAD rating of at least 'good' by 53.1%. HECSI-75 was achieved by 59.3% and (almost) clear on the Photographic guide by 74.1%. The minimally important change in QOLHEQ was achieved by 57.9%. Sub-analysis in patients with concomitant irritant contact dermatitis showed no differences. Safety analysis showed no new findings compared to clinical trials. Conclusions: Upadacitinib can be an effective treatment for patients with AD and concomitant HE in daily practice. Future studies should focus on the effectiveness of upadacitinib on chronic HE, especially on the different etiological subtypes of HE, including HE in non-atopic individuals. Esmé Kamphuis and Laura Loman share the first authorship.

Upadacitinib treatment in a real‐world difficult‐to‐treat atopic dermatitis patient cohort

“…One study (including 38 patients) showed that upadacitinib treatment can also be an effective treatment for AD patients with concomitant hand-eczema. 20 Chirricozi et al and Gargiulo et al showed a comparable decrease in AD outcome measurements (in 43 and 38 patients, respectively) to our study (IGA, NRS itch), however the follow up of these short-term studies were only 16 weeks, compared to a maximum of 54 weeks in our study. 21,22 The percentage of patients reporting an AEs in our cohort was 56%, comparable to previous clinical trials that reported 53%-73% patients with at least one AE.…”

“…In addition, three larger real‐world studies have been published. One study (including 38 patients) showed that upadacitinib treatment can also be an effective treatment for AD patients with concomitant hand‐eczema 20 . Chirricozi et al.…”

Treatment of atopic dermatitis with upadacitinib: adcare single center experience

“…Despite the predictable short response time to upadacitinib therapy, described in other real-world studies ( 19 , 20 ), 44% of patients did not reach a ΔEASI 50 by the end of 1 month of follow-up. The scientific community has to determine an effective strategy for these cases.…”

New Perspectives in the Management of Chronic Hand Eczema: Lessons from Pathogenesis

“…In the BioDay registry, 32 patients with atopic dermatitis and comorbid contact hand eczema were followed. A HECSI-75 score was achieved by 59.3% of patients, and 74.1% achieved (almost) clear skin, as assessed by the photographic guide [ 35 ]. Acne was the most common adverse reaction encountered in the preliminary trials.…”