Efficacy and safety of upadacitinib in the treatment of moderate-to-severe atopic dermatitis: A systematic review

TL;DR

This study reviews the effectiveness and safety of upadacitinib for treating moderate-to-severe atopic dermatitis, finding it to be both effective and safe.

Contribution

A systematic review and meta-analysis of upadacitinib's efficacy and safety in treating moderate-to-severe atopic dermatitis.

Findings

Upadacitinib significantly improved EASI 75%, NRS ≥ 4, and IGA 0/1 scores compared to placebo.

The 30 mg dose of upadacitinib was more effective than the 15 mg dose.

Upadacitinib increased overall adverse events but did not significantly increase serious adverse events or withdrawal rates.

Abstract

To evaluate the efficacy and safety of upadacitinib in the treatment of moderate-to-severe atopic dermatitis (AD), and provide reference for rational clinical medication.

PubMed, Medline, Embase, Web of Science, Clinical Trials Website, and Cochrane Library databases were searched from the time of establishment until January 6, 2024, to compile a list of all randomized controlled trials (RCTs) including upadacitinib in the treatment of moderate-to-severe AD. The quality of the included studies was evaluated using the Cochrane Systematic Review. Review Manager 5.3 software was utilized for statistical analysis of outcome measures.

A total of five studies were included in the meta-analysis. The results revealed that the 15 mg and 30 mg upadacitinib significantly improved Eczema Area and Severity Index (EASI) 75% {[Odds Ratio (OR) = 8.58, 95% confidence interval (CI) (5.84–12.60), P < 0.00001] [OR = 15.62, 95% CI (10.89–22.42), P < 0.00001]}, Numerical Rating Scale (NRS) ≥ 4 {[OR = 7.13, 95% CI (5.63–9.01), P < 0.00001] [OR = 11.30, 95% CI (8.93–14.31), P < 0.00001]}, and Investigator’s Global Assessment (IGA) 0/1 {[OR = 8.63, 95% CI (6.60–11.27), P < 0.00001] [OR = 16.04, 95% CI (12.26–20.99), P < 0.00001]} compared to placebo. In terms of safety, although 15 mg and 30 mg upadacitinib significantly increased the overall adverse events rate compared to placebo {[OR = 1.31, 95% CI (1.09–1.58), P = 0.004] [OR = 1.85, 95% CI (1.54–2.21), P < 0.00001]}, there was no significant difference in the serious adverse events rate {[OR = 0.73, 95% CI (0.41–1.29), P = 0.28] [OR = 0.69, 95% CI (0.39–1.23), P = 0.21]} and withdrawal rate due to adverse events {[OR = 0.66, 95% CI (0.39–1.11), P = 0.12] [OR = 0.85, 95% CI (0.52–1.38), P = 0.50]} compared to placebo.

This meta-analysis preliminarily suggests that upadacitinib is effective and safe for usage in the treatment of moderate-to-severe AD. Additionally, upadacitinib can instantly relieve itchiness and effectively reduce symptoms and signs, with its 30-mg dose being more effective than the 15-mg dose.

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