Dupilumab for atopic dermatitis has only just made it onto the PBS but already a competing product is making its mark in clinical trials.
The JAK1 inhibitor abrocitinib has stacked up well against dupilumab and better than placebo in a phase 3 RCT of adults with moderate to severe atopic dermatitis unresponsive to topical therapies.
The JADE COMPARE trial randomised 838 patients from 18 countries including Australia to either abrocitinib (200 or 100 mg oral once daily) or dupilumab (300 mg subcut fortnightly) or placebo. Patients also received background topical therapy.
The Investigator’s Global Assessment (IGA) response at 12 weeks was highest with 200 mg abrocitinib (48.4%) compared to 100 mg abrocitinib (36.6%), dupilumab (36.5%) and placebo (14.0%).
Similarly the EASI-75 response was superior with the high dose JAK1 inhibitor (70.3%) compared to all other arms of the study (58.7%, 58.1% and 27.1% respectively).
The study, published in the NEJM, found the same pattern in both endpoints at week 16.
An itch response at week 2 – an improvement of at least four points from baseline on the Peak Pruritus Numerical Rating Scale (PP-NRS) – was seen in 49.1% with 200 mg abrocitinib, 31.8% with 100mg abrocitinib, 26.4% with dupilumab and 13.8% with placebo.
Adverse events including nausea and acne were more common in the 200mg abrocitinib arm.
Despite the limitations of the study such as the short time frame, the investigators including Melbourne dermatologist Professor Rod Sinclair, concluded that abrocitinimb at either dose was superior to placebo and similar to dupilumab on most endpoints.
“Longer and larger trials are necessary to determine the efficacy and safety of abrocitinib and to compare it with other JAK inhibitors and with biologic agents used for the treatment of atopic dermatitis,” they said.
A study published last year in JAMA Dermatology found once-daily oral abrocitinib, at 200 mg or 100 mg, was well tolerated and effective compared with placebo in both adolescents and adults with moderate-to-severe disease.
Disclosures: The JADE COMPARE trial was funded by Pfizer.