Costanzo (Humanitas): “Upadacitinib inhibits itching in atopic dermatitis”

It occurs with the sudden formation of dry, itchy skin and red blistering patches. It is atopic dermatitis, which in Italy affects between 2 and 8% of adults; the severe form of the disease affects tens of thousands of patients. “The main symptoms can arise at any age – says Antonio Costanzo, head of the Dermatology Unit at Humanitas in Milan – The problem is that, when the disease appears, it has a devastating impact on the quality of life of patients. , in moderate as in severe forms. Itching, during the night, does not make them sleep and is a reason for stress throughout the day, together with the presence of patches that can also appear on the face and hands. for the treatment of atopic dermatitis there is upadacitinib, a drug that has shown a marked clinical activity: it inhibits itching, reduces the severity of the disease and improves symptoms, consequently also has positive effects on the quality of life of patients ” . The new therapies, including the Jak-inhibitor upadacitinib, used to control atopic dermatitis, are among the topics at the center of the 30th Congress of the European Academy of Dermatology and Venereology (EADV), scheduled from 29 September to 2 October in virtual mode due to anti-Covid regulations. Atopic dermatitis does not spare even the little ones, Costanzo emphasizes. “About 30% of children under 6 years – explains the specialist – manifest atopic dermatitis, the symptoms of which fortunately are resolved: it is no coincidence that from the age of 12 the percentage of patients affected” by the disease “is greatly reduced”. “Upadacitinib – continues the Humanitas expert – is part of the Jak inhibitors which are kinases, small proteins present inside the cell, which signal inflammation. Upadacitinib is able to inhibit and block the inflammatory signal and the itching in a short time “. “The new studies presented at the EADV 2021 Congress – reports Costanzo – tell us that it is a safe and effective molecule. From the data on the efficacy of upadacitinib compared to the most widely used drug for atopic dermatitis, the dupilumab monoclonal antibody, it emerges that it is a drug with speed of action (it can stop the itching in a few hours), and capable of maintaining the cleansing of the skin from atopic dermatitis over time, at least up to a year. This drug has been shown in a head study head presented at the EADV Congress, is superior to dupilumab because it is able to clean many more patients (30%) of atopic dermatitis than dupilumab. Even in clinical practice, we have found in our patients rapid improvement levels that they are maintained over time. It is certainly a very interesting novelty that we hope will be available to our patients in the coming months “. The Committee for Medicinal Products for Human Use (Chpm) of the European Medicines Agency (Ema) also issued its positive opinion for upadacitinib (trade name Rinvoq *), a selective and reversible oral Jak inhibitor, for the treatment of adults. (15 mg or 30 mg once daily) and adolescents from 12 years of age (15 mg once daily) with moderate to severe atopic dermatitis, candidates for systemic therapy. Upadacitinib is also undergoing clinical development in other immune-mediated inflammatory diseases. The positive opinion of the CHMP is supported by clinical data from the Phase III development program which evaluated over 2,500 patients with moderate to severe atopic dermatitis in three clinical studies: Measure Up 1, Measure Up 2 and Ad Up. Across the three studies, both upadacitinib doses met all primary and secondary endpoints, demonstrating rapid and significant improvement in skin clearance and reduction in pruritus compared to placebo at week 16 in patients with moderate to severe atopic dermatitis. The most commonly reported adverse events in patients treated with upadacitinib were acne, nasopharyngitis, upper respiratory tract infections, headache, increased creatine phosphokinase (Cpk) and oral herpes. “The fact that Ema has approved this drug for the treatment of atopic dermatitis in both adults and adolescents – comments the dermatologist – is a huge step forward, because we can now be able to quickly control the disease and its symptoms. impact on the quality of life, even from the point of view of social relationships, in a terrible way. There are teenagers who lock themselves up at home because of the disease. With this new class of drugs, finally, patients can return to see the light ” .

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