Upadacitinib treatment for atopic dermatitis patients has been associated with acne. However, a phase 3 randomized control trial has revealed that the severity of this adverse event is typically mild-to-moderate, and can be effectively managed through the use of topical therapies or left untreated.
These findings are reported in the Journal of the American Academy of Dermatology.
Upadacitinib, a potent oral Janus kinase (JAK) inhibitor with a higher inhibitory effect on JAK1 compared to JAK2, JAK3, and tyrosine kinase, has been approved for use in the treatment of moderate-to-severe atopic dermatitis (AD), rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and ulcerative colitis in adults in over 50 countries.
Acne More Prevalent in Moderate-to-Severe AD
Patients with moderate-to-severe (AD) who received upadacitinib experienced acne more frequently than those who received a placebo; higher rates of acne were seen with 30 mg upadacitinib than with 15 mg. Acne was reported in 7% to 13% of cases of AD in which upadacitinib 15 mg was used, and 14% to 17% with upadacitinib 30 mg. On the other hand, placebo resulted in acne in just 2% of cases. In other diseases, including rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, incidence of acne was <2%, and in ulcerative colitis, it was ≤6%.
Acne Recurrence Appeared Six Weeks Post-Treatment
Acne usually appeared after nearly 6 weeks of upadacitinib treatment and lasted approximately three months; acne recurrence throughout the 16-week placebo-controlled period was uncommon, occurring in less than 1% of upadacitinib-treated individuals.
The acne had no effect on the patients’ quality of life since upadacitinib responders with/without acne and nonresponders with/without acne had comparable Dermatology Life Quality Index (DLQI) values. Furthermore, acne did not affect patient satisfaction with upadacitinib, as judged by the Patient Global Impression of Treatment (PGIT) scores.
Acne Post-Treatment Was Clinically Manageable
Acne was clinically tolerable, and almost half of the individuals who experienced it required no treatment; the majority of those who did require treatment utilized only topical medications (most commonly antibiotics, benzoyl peroxide, and retinoids, given alone or in combination). Only 4.8% and 7.6% of patients who developed acne while taking upadacitinib 15 mg and 30 mg, respectively, required oral treatment, predominantly with tetracycline antibiotics; one patient received an oral retinoid.
Females, Non-Whites, and Younger Patients Were More Acne-Prone
According to the findings of the study, females and non-Whites were at a higher risk of developing acne regardless of the treatment they received.
Additionally, Pedro Mendes-Bastos, the article’s first author, notes: “Similar to the general population, acne incidence in patients taking upadacitinib decreased with advancing age.”
This study was relatively brief and involved a limited number of participants. Future studies with a large sample size should be conducted. Moreover, further studies are required to elucidate the mechanism behind the acne that is related to JAK inhibitors.
Mendes-Bastos, P., Ladizinski, B., Guttman-Yassky, E., Jiang, P., Liu, J., Prajapati, V. H., Simpson, E. L., Vigna, N., Teixeira, H. D., & Barbarot, S. (2022). Characterization of acne associated with upadacitinib treatment in patients with moderate-to-severe atopic dermatitis: A post hoc integrated analysis of 3 phase 3 randomized, double-blind, placebo-controlled trials. J Am Acad Dermatol, 87(4), 784-791. https://doi.org/10.1016/j.jaad.2022.06.012