Upadacitinib

Yang Y, et al. International Immunopharmacology, 2024, 143(1), 113383.

Recent real-world evidence supports the efficacy and safety of Upadacitinib, a selective Janus kinase (JAK) inhibitor, in treating moderate to severe atopic dermatitis (AD). In a single-center retrospective cohort study, 46 patients receiving Upadacitinib demonstrated a rapid and significant reduction in Eczema Area and Severity Index (EASI), Atopic Dermatitis Control Tool (ADCT), and Numeric Rating Scale (NRS) scores over 12 weeks.
Compared to Dupilumab, another treatment for AD, Upadacitinib showed faster and more pronounced improvements in key inflammatory markers. By week 12, Upadacitinib-treated patients exhibited a significantly greater decrease in serum levels of interleukins IL-4, IL-13, and IL-31, highlighting its robust anti-inflammatory action. While Dupilumab significantly reduced total IgE levels, no corresponding change was observed in the Upadacitinib group.
Upadacitinib was associated with a higher incidence of mild adverse events, but no serious adverse events were reported, confirming its safety profile. These findings suggest that Upadacitinib offers superior efficacy with a rapid onset of action for managing moderate to severe AD, providing a valuable treatment option for patients requiring prompt symptom relief.

Colombel JF, et al. Clinical Gastroenterology and Hepatology, 2024.

Upadacitinib has shown significant efficacy in managing moderate-to-severe Crohn's disease, particularly in patients with fistulizing disease. This post hoc analysis of phase 3 clinical trials (U-EXCEL, U-EXCEED, and U-ENDURE) evaluated the outcomes of upadacitinib on fistula resolution and overall disease management. In the induction trials, patients were randomized to receive either upadacitinib 45 mg daily or a placebo for 12 weeks. Clinical responders to upadacitinib were subsequently rerandomized to maintenance doses of 15 mg or 30 mg daily or a placebo for 52 weeks. Among patients with fistulizing Crohn's disease (n=143, 14.0%), including 128 with perianal fistulas, upadacitinib demonstrated superior efficacy compared to placebo.
By the end of the induction phase, 44.7% of patients receiving upadacitinib achieved resolution of perianal fistula drainage versus 5.6% with placebo (P = .003). Closure of external fistula openings was also more frequent with upadacitinib during induction (22.1% vs 4.8%; P = .013). Maintenance therapy with upadacitinib further sustained these benefits. These findings underscore upadacitinib's potential as a targeted therapy for fistulizing Crohn's disease, offering improved clinical and endoscopic outcomes compared to placebo.