Gao Qin, Zhao Yanxia, Zhang Junling
Department of Dermatology, Tianjin Institute of Integrative Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital.
Heliyon. 2023 Jun 2;9(6):e16704. doi: 10.1016/j.heliyon.2023.e16704. eCollection 2023 Jun.
The sparsity of head-to-head trials for medications used as in atopic dermatitis (AD) treatment makes therapy options difficult.
To better compare the efficacy and safety of abrocitinib and upadacitinib with dupilumab in patients with moderate-to-severe AD.
We systematically searched MEDLINE, EMBASE, and the Cochrane Library database for head-to-head trials.
Three studies with 2256 patients were included. The analysis revealed that improvement of EASI-75 was rapidly registered with abrocitinib/upadacitinib as compared to the dupilumab, even as early as week 2 of treatment. The proportions of patients who reached the endpoint of EASI-75 at week 12 and end of therapy were also higher in the abrocitinib/upadacitinib group. Significant improvement in EASI-90 scores was demonstrated with abrocitinib/upadacitinib at week 2 and at all subsequent time points. The administration of abrocitinib/upadacitinib provided a faster onset of IGA response at week 2. The differences in IGA response remained significant at week 12 and end of therapy. Compared with dupilumab, a larger proportion of patients treated with abrocitinib/upadacitinib achieved early itch relief at 2 weeks. Better results were found later during treatment, in between the 12 weeks to the end of study in abrocitinib/upadacitinib group. The only observed significant result of adverse events were severe adverse events between the abrocitinib/upadacitinib group (n = 40) and the dupilumab group (n = 24) (p = 0.043). TEAEs of any causality that led to treatment discontinuation and serious adverse events have not shown special risks in the patients treated with abrocitinib/upadacitinib.
This study demonstrated that -JAK therapy, particularly abrocitinib and upadacitinib, exhibited superiority over dupilumab in achieving fast relief of disease signs with an acceptable safety profile in patients with moderate-to-severe atopic dermatitis.
用于特应性皮炎（AD）治疗的药物缺乏头对头试验，这使得治疗选择变得困难。
更好地比较阿布昔替尼、乌帕替尼与度普利尤单抗在中重度AD患者中的疗效和安全性。
我们系统检索了MEDLINE、EMBASE和Cochrane图书馆数据库中的头对头试验。
纳入了三项研究，共2256例患者。分析显示，与度普利尤单抗相比，阿布昔替尼/乌帕替尼治疗后EASI-75改善迅速，甚至在治疗第2周时就已出现。在第12周和治疗结束时达到EASI-75终点的患者比例，阿布昔替尼/乌帕替尼组也更高。在第2周及之后所有时间点，阿布昔替尼/乌帕替尼均显示出EASI-90评分有显著改善。阿布昔替尼/乌帕替尼治疗在第2周时IGA反应起效更快。在第12周和治疗结束时，IGA反应差异仍显著。与度普利尤单抗相比，接受阿布昔替尼/乌帕替尼治疗的患者中有更大比例在2周时实现了早期瘙痒缓解。在治疗后期，即治疗第12周至研究结束期间，阿布昔替尼/乌帕替尼组效果更佳。观察到的唯一显著不良事件结果是阿布昔替尼/乌帕替尼组（n = 40）和度普利尤单抗组（n = 24）之间的严重不良事件（p = 0.043）。导致治疗中断的任何因果关系的TEAE以及严重不良事件在接受阿布昔替尼/乌帕替尼治疗的患者中未显示出特殊风险。
本研究表明，JAK疗法，尤其是阿布昔替尼和乌帕替尼，在中重度特应性皮炎患者中实现疾病体征快速缓解且安全性可接受方面，优于度普利尤单抗。
