Effectiveness of switching from baricitinib 4 mg to upadacitinib 30 mg in patients with moderate-to-severe atopic dermatitis: a real-world clinical practice in Japan

Abstract

Background

Atopic dermatitis (AD) is a chronic eczematous disease with severe pruritus. Janus kinase (JAK) inhibitors, upadacitinib, baricitinib, and abrocitinib, are systemic treatments for AD. The outcomes of switching from one JAK inhibitor to another have not been examined.

Objectives

We assessed the outcomes of switching from baricitinib 4 mg to upadacitinib 30 mg in Japanese patients with moderate-to-severe AD.

Methods

Twenty patients treated with baricitinib 4 mg, showing insufficient response or adverse events, were switched to treatment with upadacitinib 30 mg. We evaluated total eczema area and severity index (EASI), EASI at head and neck, trunk, upper, or lower limbs, EASI of erythema, edema/papulation, excoriation, or lichenification, and peak pruritus numerical-rating scale (PP-NRS) at baseline (start of baricitinib), weeks 0 (time of switching), and 4 and 12 after switching.

Results

Total EASI, EASI at each anatomical site, EASI of each clinical sign, and PP-NRS were markedly reduced at weeks 4 or 12 compared to week 0. Achievement rates of more than 75% or 90% reduction of EASI from baseline significantly improved after switching.

Conclusions

Switching from baricitinib 4 mg to upadacitinib 30 mg effectively improved rash and pruritus.

Keywords:

• Atopic dermatitis
• baricitinib
• Janus kinase
• switch
• upadacitinib

Author contributions

Teppei Hagino conceptualized the study, and mainly organized the manuscript. Mai Yoshida and Risa Hamada performed the statistical analyses. Naoko Kanda supervised the study. Hidehisa Saeki and Eita Fujimoto revised the manuscript.

Disclosure statement

Hidehisa Saeki received a lecture fee and research cost from AbbVie GK. Teppei Hagino, Hidehisa Saeki and Naoko Kanda received lecture fees from AbbVie GK and Eli Lilly.

Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Additional information

Funding

This research was partially supported by the grant, Initiative for Realizing Diversity in the Research Environment from MEXT, Japan.