Efficacy of Abrocitinib and Dupilumab in Patients With Moderate-to-Severe Atopic Dermatitis With Severe Itch at Baseline and in Subgroups by Baseline Thresholds of Severe Itch: A Post Hoc Analysis of the JADE COMPARE and JADE DARE Clinical Trials

Abstract

Introduction: In phase 3 trials, abrocitinib provided more rapid and greater itch relief than dupilumab in patients with moderate-to-severe atopic dermatitis (AD). We examined the efficacy of abrocitinib versus dupilumab in patients with severe itch at baseline (BL) and in subgroups by BL thresholds of severe itch.
Methods: Data were pooled from patients treated with abrocitinib 200 mg or dupilumab 300 mg in JADE COMPARE (NCT03720470) and JADE DARE (NCT04345367). Patients with severe itch at BL (Peak Pruritus Numerical Rating Scale [PP-NRS] ≥7), and subgroups by BL PP-NRS 7-10 were assessed for achievement of ≥4-point improvement in PP-NRS (PP-NRS4) and PP-NRS 0/1 (itch free state). Subgroups were also assessed for achievement of Patient Oriented Eczema Measure (POEM) score ≤2 (clear/almost clear AD), and Dermatology Life Quality Index (DLQI) score of 0/1 (no impact on quality of life [QoL]).
Results: This analysis comprised 875 patients (abrocitinib, 453; dupilumab, 422) with severe itch at BL. Median (Q1, Q3) BL score for PP-NRS was 8.0 (7.0, 9.0) in the abrocitinib arm and 8.0 (7.0, 9.0) in the dupilumab arm; 22.0 (19.0, 26.0) and 22.0 (19.0, 27.0) for POEM; 16.0 (11.0, 20.5) and 16.0 (11.0, 20.0) for DLQI. In the overall group, PP-NRS4 responses were greater with abrocitinib versus dupilumab as early as week 2 (56% vs 32%) and sustained through week 16 (73% vs 69%). Stringent PP-NRS 0/1 responses were greater with abrocitinib versus dupilumab at weeks 2 (15% vs 3%) and 16 (35% vs 21%). Across patient subgroups by BL PP-NRS 7-10, greater proportions achieved PP-NRS4 and PP-NRS 0/1 with abrocitinib versus dupilumab at weeks 2 and 16. Greater proportions across subgroups achieved POEM ≤2 with abrocitinib compared with dupilumab at week 16 (BL PP-NRS7, 33% vs 10%; BL PP-NRS8, 29% vs 20%; BL PP-NRS9, 39% vs 16%; BL PP-NRS10, 31% vs 23%). In the overall group, greater proportions achieved DLQI 0/1 with abrocitinib versus dupilumab at weeks 2 (19% vs 6%) and 16 (38% vs 27%). Across subgroups, DLQI 0/1 responses with abrocitinib were generally greater than dupilumab at weeks 2 and 16.
Conclusions: In patients with moderate-to-severe AD who had severe itch at BL, abrocitinib provided more rapid and complete/near complete itch relief and improved QoL than dupilumab as early as 2 weeks of treatment. These results were consistent across subgroups by various BL thresholds of severe itch.