Expectations rise for Rinvoq in treating severe AD

With its enhanced convenience and effect

Unlike ‘Dupixent,’ which targets key cytokines, Rinvoq provides more broader involvement

Is recognized for catching ‘both birds with one stone,’ with its immediate effect and convenience in administration

“Shows large symptom improvement even when switching from Dupixent→Rinvoq… the drug’s long-term effect remains to be seen.”

A second JAK inhibitor has been introduced to the field of moderate-to-severe atopic dermatitis treatment.

 

Abbvie’s ‘Rinvoq (upadacitinib),’ with its double advantage in improved convenience and effect, is heralding new change in the field of AD treatment.

 

Rinvoq was additionally approved for the atopic dermatitis indication on the 6th last month by the Ministry of Food and Drug Safety.

 

With the approval, Rinvoq is now approved for patients with moderate-to-severe atopic dermatitis in adults and adolescents over the age of 12.

 

Rinvoq became the second JAK inhibitor after ‘Olumiant’ to be approved for atopic dermatitis.

 

Also, the addition of Rinvoq increased the number of options for AD to three – the biological drug ‘Dupixent,’ and JAK inhibitors Rinvoq and Olumiant – in an area where no new drug had been introduced for a long period of time.

 

◆Dupixent’ targets specific cytokines – ‘Rinvoq’ provides broader inhibition Numerous inflammatory mediators are entangled like a web in atopic dermatitis, and Dupixent and the JAK inhibitor Rinvoq treat atopic dermatitis with different mechanisms of action.

 

Dupixent selectively and potently inhibits IL-4 and IL-13, the key and central drivers of the type 2 inflammation that causes atopic dermatitis.

 

It provides a higher effect by targeting specific cytokines, but also may not be effective in some patients.

 

On the other hand, JAK inhibitors including Rinvoq provide broader cytokine inhibition.

 

Cytokines bind to the cell surface receptors to deliver signals through the JAK-STAT and other signaling pathways, and JAK inhibitors target the JAK enzymes that command the protein that plays a pivotal role in immune/inflammatory regulation.

 

Among the JAK enzymes, Rinvoq specifically targets JAK1, which not only includes IL-4 and IL-13, but also is involved in various other cytokines including the itch-specific cytokine IL-31, keratin-involved TSLP, IL-22 that thickens the skin, and interferon-gamma.

 

▲ Yong-hyun Jang, Professor of Dermatology at Kyungpook National University College of Medicine

This mechanism of action is how RInvoq was able to show immediate effect in such a short period of time.

 

At the RInvoq press conference that was held on the 9th, Yong-Hyun Jang, Professor of Dermatology at Kyungpook National University College of Medicine, said, “Inhibiting only IL-4 and IL-13 cannot be a complete solution to atopic dermatitis, as the immunopathological mechanism of atopic dermatitis is very complex, and manifests differently by race or age.

 

The introduction of Rinvoq has resolved this unmet need.” Also, another difference between the two drugs that arise from the differences in mechanisms is in their method of administration.

 

The biologic Dupixent is an injection and JAK inhibitors like RInovq are small molecule inhibitors that can be taken orally.

 

Rinvoq can be a more convenient option for patients who have difficulty making regular visits to hospitals for injections.

 

Oral drugs also have the advantage of allowing easier dosage adjustments fit for each patients’ condition.

 

◆Rises among JAK inhibitors with its superior data… achieves convenience in administration and effect Another advantage of Rinvoq is its excellent clinical data.

 

In Phase III studies that compared RInvoq with placebo (Measure Up1, Measure Up2, AD Up), 60~70% of patients who received Rinvoq achieved EASI75 (at least a 75% improvement in the Eczema Area Severity Index) at Week 16.

 

The proportion was 70-80% in patients who receive a higher dose (30mg).

 

Also, 42-53% (higher dose 58-66%) achieved EASI90 (at least 90% improvement).

 

Also, RInvoq significantly reduced itching, the symptom patients find most difficult to bear, in about half of the patients.

 

42~53% (Worst Pruritus improvement≥4) The results were more positive than the data from Olumiant, where about half of phase 3 participants reached EASI75.

 

In addition, Rinvoq also demonstrated superior efficacy and safety in a head-to-head trial compared to Dupixent, which has the sole lead in treating moderate-to-severe atopic dermatitis.

 

In the 3b Heads Up study, 71.0% of patients treated with Rinvoq achieved EASI 75 at week 16, which was higher than the 61.0% in the Dupixent-treated group

▲ Dong-hoon Lee, Professor of Dermatology at Seoul National University Hospital

Also, recently updated analysis data shows that switching from dupilumab to RInvoq had shown significant improvement.

 

Dong-hoon Lee, Lee of Dermatology at Seoul National University Hospital, said, “Both the patients who showed response or no response to dupilumab showed significant improvement when switching from dupilumab to Rinvoq at Week 24 or later.

 

And the effect continued until Week 52.

 

The significant improvement in skin clearance and itching reduction even after switching was notable.”