Efficacy and Safety of Upadacitinib in Patients With Moderate to Severe Atopic Dermatitis: Analysis of Follow-up Data From the Measure Up 1 and Measure Up 2 Randomized Clinical Trials

Key Points

Question  Is upadacitinib efficacy and safety maintained through 52 weeks of continuous treatment in patients with moderate to severe atopic dermatitis?

Findings  In this analysis of follow-up data from the large, global, replicate phase 3 Measure Up 1 and Measure Up 2 randomized clinical trials including a total of 1609 patients, once-daily upadacitinib (15 mg or 30 mg) provided durable efficacy with responses maintained through 52 weeks of treatment. No new safety risks were observed.

Meaning  This follow-up analysis of 2 randomized clinical trials found that continuous upadacitinib treatment showed a favorable longer-term benefit-risk profile in patients with moderate to severe atopic dermatitis.

Importance  Primary results from the Measure Up 1 and Measure Up 2 studies demonstrated upadacitinib efficacy and safety through 16 weeks in patients with atopic dermatitis. Longer-term outcomes remain unknown.

Objective  To evaluate long-term (52 weeks) efficacy and safety of upadacitinib treatment in patients with atopic dermatitis.

Design, Setting, and Participants  Measure Up 1 and Measure Up 2 are ongoing double-blind, placebo-controlled, replicate phase 3 randomized clinical trials that include adults and adolescents with moderate to severe atopic dermatitis at 151 and 154 centers, respectively. Cutoffs for this analysis were December 21, 2020 (Measure Up 1), and January 15, 2021 (Measure Up 2).

Interventions  Patients were randomized 1:1:1 to receive once-daily oral upadacitinib 15 mg, 30 mg, or placebo. At week 16, patients randomized at baseline to receive upadacitinib 15 mg (273 and 260 patients in Measure Up 1 and Measure Up 2, respectively) and 30 mg (270 and 268 patients) continued assigned treatment; placebo-treated patients were rerandomized 1:1 to receive upadacitinib 15 mg (121 and 120 patients in Measure Up 1 and Measure Up 2, respectively) or 30 mg (123 and 121 patients) in a double-blinded manner.

Main Outcomes and Measures  Safety and efficacy, including 75% improvement in the Eczema Area and Severity Index and Validated Investigator Global Assessment for Atopic Dermatitis score of clear (0) or almost clear (1) with 2 or greater grades of improvement, were assessed.

Results  Measure Up 1 and Measure Up 2 included a total of 1609 patients (mean [SD] age, 33.8 [15.6] years; 727 women [45.2%]; 882 men [54.8%]). Efficacy at week 16 was maintained through week 52. At week 52, 75% improvement in the Eczema Area and Severity Index was achieved by 82.0% (95% CI, 77.0%-86.9%) and 79.1% (95% CI, 73.9%-84.4%) of patients continuing the 15-mg dose and 84.9% (95% CI, 80.3%-89.5%) and 84.3% (95% CI, 79.6%-89.0%) of patients continuing the 30-mg dose (for Measure Up 1 and Measure Up 2, respectively); Validated Investigator Global Assessment for Atopic Dermatitis score of clear (0) or almost clear (1) with 2 or greater grades of improvement was achieved by 59.2% (95% CI, 52.9%-65.5%) and 52.6% (95% CI, 46.2%-59.1%) and 62.5% (95% CI, 56.3%-68.7%) and 65.1% (95% CI, 58.9%-71.2%) of patients in the Measure Up 1 and Measure Up 2 studies, respectively. Treatment discontinuation due to adverse events was low overall but was slightly higher for the upadacitinib 30-mg dose. Both upadacitinib doses were well tolerated with no new safety signals.

Conclusions and Relevance  In this analysis of follow-up data from 2 randomized clinical trials, longer-term treatment of adolescents and adults with moderate to severe atopic dermatitis with upadacitinib demonstrated a favorable benefit-risk profile, with sustained efficacy responses through 52 weeks.

Trial Registration  ClinicalTrials.gov Identifiers: NCT03569293 (Measure Up 1) and NCT03607422 (Measure Up 2)

Long-term oral treatment options are limited for patients with moderate to severe atopic dermatitis (AD) recalcitrant to topical therapy; most conventional oral immunosuppressive therapies are used off-label, have limited efficacy data, and are not suitable for long-term treatment owing to their safety profiles.^1-3 Additionally, the proportion of patients achieving clear or almost-clear skin with the injectable immunotherapy dupilumab after 16 weeks is less than 50%.⁴ There remains an unmet need for efficacious and well-tolerated oral medications that provide rapid, sustained itch relief and skin clearance and improve quality of life for patients with moderate to severe AD.

Upadacitinib (Rinvoq; AbbVie Inc) is being investigated to treat AD in adolescents and adults.^5-9 The week-16 results from the Measure Up 1 and Measure Up 2 studies¹⁰ demonstrated that upadacitinib was superior to placebo across assessments of disease activity, itch, skin pain, and impact of AD on quality of life and had a favorable benefit-risk profile in patients with moderate to severe AD. Clinically and statistically significant improvements in itch were observed as early as 2 days after the first dose of upadacitinib, and skin clearance (≥75% improvement in Eczema Area and Severity Index [EASI]) was observed as early as week 2.¹⁰ Both the 15-mg and 30-mg upadacitinib doses were well tolerated; no new important safety risks beyond the labeled upadacitinib safety profile were observed through week 16.¹⁰ Because AD is a chronic disease,^11,12 the evaluation of the long-term benefit-risk profile of upadacitinib as monotherapy continues in the ongoing blinded extension (BE) period of Measure Up 1 and Measure Up 2. Here, we report results through 52 weeks of the BE period.

A detailed description of the study design and patient population of the Measure Up 1 (NCT03569293) and Measure Up 2 (NCT03607422) studies was previously reported.¹⁰ Briefly, both studies are ongoing global, multicenter, double-blind, placebo-controlled, replicate phase 3 randomized clinical trials conducted in 151 and 154 centers in Measure Up 1 and Measure Up 2, respectively. Both studies consisted of a 35-day screening period, a 16-week double-blind treatment period, and a BE period up to week 260. This 52-week analysis was prespecified in the trial protocol.

Patients aged 12 to 75 years with moderate to severe AD (defined as ≥10% of body surface area affected by AD, EASI ≥16, Validated Investigator Global Assessment for AD [vIGA-AD]¹³ ≥3, and Worst Pruritus Numerical Rating Scale [WP-NRS] ≥4 [weekly average]) who were candidates for systemic therapy were eligible to participate. The study was conducted in accord with the International Conference for Harmonisation guidelines, applicable regulations and guidelines governing clinical study conduct, and ethical principles originating from the Declaration of Helsinki. Before patient enrollment, independent ethics committees and/or institutional review boards approved the study protocol, informed consent form(s), and recruitment materials. Patients or their parents or legal guardians provided written informed consent before screening.

At study entry, patients were randomized 1:1:1 to receive a daily oral dose of upadacitinib 15 mg, upadacitinib 30 mg, or placebo. Randomization was stratified by baseline vIGA-AD (moderate, severe), geographic region (Measure Up 1, US/Puerto Rico/Canada, Japan, China, and other; Measure Up 2, US/Puerto Rico/Canada and other), and age group (adolescent, adult). At week 16, patients initially randomized to upadacitinib 15 mg or upadacitinib 30 mg continued treatment as originally assigned. Placebo-treated patients were rerandomized 1:1 at week 16 to upadacitinib 15 mg or 30 mg; randomization was stratified by EASI 50 response at week 16, age group, and geographic region. Study investigators, site personnel, and patients were masked to treatment assignment in the double-blind period and masked to dose in the BE period. Starting at week 16, only systemic treatments for AD were considered as rescue therapy; topical medications for AD could be used at the investigator’s discretion.

Efficacy end points, including skin clearance, itch relief, and quality of life, were assessed through week 52 (see eMethods in Supplement 1). Safety parameters included treatment-emergent adverse events (AEs), serious AEs, AEs leading to discontinuation of study drug, deaths, AEs of special interest (AESI), and incidence of potentially clinically significant laboratory assessments.

After all patients in the main study (adolescents and adults) completed week 52, efficacy analyses were conducted in the intention-to-treat (ITT) population, defined as all patients who were randomized at baseline in the main study. Safety analyses were performed up to the cutoff date of the week-52 analysis (Measure Up 1, December 21, 2020; Measure Up 2, January 15, 2021). The safety population included all patients in the main study who received at least 1 dose of study drug. Efficacy and safety analyses were performed for each study and for the integrated data from Measure Up 1 and Measure Up 2.

Observed case (OC) analysis during treatment with the study drug, which did not impute missing data, was the primary analysis approach used for all variables. Adverse events were summarized using exposure-adjusted event rate (EAER, events/100 patient years [PYs]), calculated as the number of AEs divided by the total exposure in 100 PYs. Laboratory assessments indicating potentially clinically significant findings were reported as the number and proportion of patients. Missing safety data were not imputed. See eMethods in Supplement 1 for additional details on statistical analysis.

Demographic and baseline disease characteristics were well balanced between groups (Table 1).¹⁰ A total of 273 and 260 patients (Measure Up 1 and Measure Up 2, respectively) randomized at baseline to upadacitinib 15 mg and 270 and 268 patients to upadacitinib 30 mg continued to receive their initial treatment in the BE period and had a minimum 52 weeks of upadacitinib exposure (eFigure 1 in Supplement 1). At week 16, 485 placebo-treated patients were rerandomized (121 and 120 to upadacitinib 15 mg, 123 and 121 to upadacitinib 30 mg in Measure Up 1 and Measure Up 2, respectively); these patients had a minimum of 36 weeks’ upadacitinib exposure. During the BE period, only 1 patient permanently discontinued treatment because of COVID-19 diagnosis. This patient was treated with placebo/upadacitinib, 30 mg, in Measure Up 2. From weeks 16 to 52, concomitant topical corticosteroids/topical calcineurin inhibitor therapy was used by 79 of 281 patients (28.1%) in the upadacitinib 15-mg group and 70 of 285 patients (24.6%) in the upadacitinib 30-mg group in Measure Up 1 and 89 of 276 patients (32.2%) and 63 of 282 patients (22.3%), respectively, in Measure Up 2. Rescue medication was initiated in the BE period for 12 of 281 (4.3%), 15 of 285 (5.3%), 2 of 121 (1.7%), and 1 of 123 (0.8%) patients receiving upadacitinib 15 mg, upadacitinib 30 mg, placebo/upadacitinib 15 mg, and placebo/upadacitinib 30 mg, respectively, in Measure Up 1, and 18 of 276 (6.5%), 11 of 282 (3.9%), 3 of 120 (2.5%), and 1 of 121 (0.8%), respectively, in Measure Up 2.

In the OC analysis in both studies, among patients who started upadacitinib treatment with the 15-mg dose on day 1, efficacy at week 52 was slightly better than at week 16 (Figures 1 and 2; eFigures 2-4 in Supplement 1); while among those who started upadacitinib treatment with the 30-mg dose on day 1, efficacy demonstrated at week 16 was maintained through week 52 (Figures 1 and 2; eFigures 2-4 in Supplement 1). At week 52, the proportions of patients who achieved EASI-75 were 82.0% (95% CI, 77.0%-86.9%) for upadacitinib 15 mg and 84.9% (95% CI, 80.3%-89.5%) for upadacitinib 30 mg in Measure Up 1 (Figure 1A, left graph), and 79.1% (95% CI, 73.9%-84.4%) and 84.3% (95% CI, 79.6%-89.0%) in Measure Up 2 (Figure 1A, middle graph). The proportion of patients who achieved vIGA-AD 0/1 at week 52 was 59.2% (95% CI, 52.9%-65.5%) for upadacitinib 15 mg and 62.5% (95% CI, 56.3%-68.7%) for upadacitinib 30 mg in Measure Up 1 (Figure 1B, left graph) and 52.6% (95% CI, 46.2%-59.1%) and 65.1% (95% CI, 58.9%-71.2%) in Measure Up 2 (Figure 1B, middle graph). At week 52, the proportion of patients who achieved WP-NRS improvement 4 or greater was 67.3% (95% CI, 61.1%-73.4%) for upadacitinib 15 mg and 67.7% (95% CI, 61.6%-73.7%) for upadacitinib 30 mg in Measure Up 1 (Figure 1C, left graph) and 62.4% (95% CI, 56.1%-68.7%) and 72.9% (95% CI, 67.1%-78.7%) in Measure Up 2 (Figure 1C, middle graph).

For the more stringent end points of EASI-90, EASI-100, vIGA-AD 0, and WP-NRS 0/1, responses were maintained or improved at week 52 vs week 16 (OC analysis). At week 52, EASI-90 was achieved by 62.7% (95% CI, 56.5%-68.9%) for upadacitinib 15 mg and 73.3% (95% CI, 67.6%-79.0%) for upadacitinib 30 mg of patients in Measure Up 1 (Figure 2A, left graph) and 61.3% (95% CI, 55.0%-67.6%) and 70.3% (95% CI, 64.4%-76.2%) in Measure Up 2 (Figure 2A, middle graph); EASI-100 was achieved by 27.9% (95% CI, 22.1%-33.7%) and 35.8% (95% CI, 29.6%-41.9%) in Measure Up 1 (Figure 2B, left graph) and 27.8% (95% CI, 22.0%-33.6%) and 35.8% (95% CI, 29.6%-42.0%) in Measure Up 2 (Figure 2B, middle graph). The proportion of patients who achieved vIGA-AD 0 at week 52 was 27.9% (95% CI, 22.1%-33.7%) for upadacitinib 15 mg and 37.1% (95% CI, 30.9%-43.3%) for upadacitinib 30 mg in Measure Up 1 (Figure 2C, left graph), and 28.3% (95% CI, 22.4%-34.1%) and 37.1% (95% CI, 30.9%-43.4%) in Measure Up 2 (Figure 2C, middle graph). At week 52, WP-NRS 0/1 was achieved by 44.8% (95% CI, 38.4%-51.2%) for upadacitinib 15 mg and 50.2% (95% CI, 43.7%-56.7%) for upadacitinib 30 mg of patients in Measure Up 1 (Figure 2D, left graph) and 41.9% (95% CI, 35.5%-48.3%) and 52.2% (95% CI, 45.7%-58.7%) in Measure Up 2 (Figure 2D, middle graph). Improvements in EASI and WP-NRS occurred rapidly (within 1 week) and continued to increase, with improvements at week 16 maintained through week 52 in both studies (eFigures 2A and 2B in Supplement 1).

Meaningful improvements occurred in several patient-reported outcome assessments, including Dermatology Life Quality Index (DLQI; eFigure 3 in Supplement 1); Hospital Anxiety and Depression Scale (HADS; eFigure 4 in Supplement 1); and the sleep, emotional state, and daily activities domains of the Atopic Dermatitis Impact Scale (ADerm-IS; eFigure 5 in Supplement 1). These improvements occurred at the earliest weekly time point at which they were assessed, with improvements at week 16 maintained through week 52.

Comparable results were obtained with the multiple imputation (categorical end points) or mixed-effects model for repeated measures (continuous end points) statistical analyses (eFigures 6-8 in Supplement 1). The integrated population (Table 2) exhibited similar efficacy results at weeks 16 (eFigure 9 in Supplement 1) and 52 (Figures 1 and 2; eFigure 2 in Supplement 1), as did the adolescent population (eFigure 10 in Supplement 1). Placebo-treated patients rerandomized at week 16 to receive upadacitinib had response rates through study week 52 similar to those who received upadacitinib from day 1 (eFigures 11-13 in Supplement 1).

Few patients treated with upadacitinib 15 mg (3.0% and 5.6%, Measure Up 1 and Measure Up 2, respectively) or upadacitinib 30 mg (3.4% and 4.9%, respectively) who experienced EASI-75 and vIGA-AD 0/1 responses at week 16 lost response, defined as loss of 50% or greater of the week-16 EASI response and vIGA-AD 2 or greater after week 16 (Table 2). Most patients who achieved EASI-75 response at week 16 maintained EASI-75 response at week 52 (87.4% and 87.3% treated with upadacitinib 15 mg in Measure Up 1 and Measure Up 2, respectively, and 88.4% and 91.0% treated with upadacitinib 30 mg in Measure Up 1 and Measure Up 2, respectively; Table 2).

Safety results are presented in Table 3. In both studies, the rate of treatment discontinuations due to AEs was low overall, though higher in the upadacitinib 30-mg group vs the 15-mg group. The EAERs of AEs, serious AEs, and AESIs at week 52 were similar or lower than EAERs observed through week 16 (eTable 1 in Supplement 1). Similar safety results were observed in the adolescent population (eTable 2 in Supplement 1).

One death (myocardial infarction related to COVID-19 diagnosis) occurred on study day 399 (28 days after last study drug dose) in a patient in their 60s treated with upadacitinib 30 mg in Measure Up 1 (Table 3); the patient had type 2 diabetes mellitus, hypertension, obesity, and hypercholesterolemia.

For the combined studies, the EAER of serious infection was higher with upadacitinib 30 mg compared with upadacitinib 15 mg (3.6/100 PYs vs 2.2/100 PYs), while the EAER of opportunistic infection (excluding tuberculosis and herpes zoster) was similar between treatment groups (1.9/100 PYs with upadacitinib 15 mg and 2.0/100 PYs with upadacitinib 30 mg; Table 3). The most common serious infection was pneumonia in Measure Up 1 and eczema herpeticum in Measure Up 2. All opportunistic infections (excluding tuberculosis and herpes zoster) were cases of eczema herpeticum or Kaposi varicelliform eruption, except for an esophageal candidiasis in a patient taking upadacitinib 30 mg. Across both studies, most events of eczema herpeticum were nonserious; 1 and 2 events reported in the upadacitinib 15-mg and 30-mg groups, respectively, led to treatment discontinuation. The EAERs of herpes zoster were higher with upadacitinib 30 mg compared with upadacitinib 15 mg (5.4/100 PYs vs 3.6/100 PYs, respectively; Table 3). Most herpes zoster events were nonserious, except for 3 in the upadacitinib 30-mg group and 2 in the upadacitinib 15-mg group. One herpes zoster event led to treatment discontinuation. Most herpes zoster (75 of 82 [91.5%]) events involved a single or 2 dermatomes; no central nervous system, ocular, lung, or liver involvement was reported. One case of tuberculosis was reported in a patient in their 20s taking upadacitinib 15-mg and another was reported in a patient in their 20s taking upadacitinib 30-mg; both were serious, deemed possibly related to study drug, and led to treatment withdrawal. Overall, the incidence of COVID-19 cases was 27 of 809 patients (3.3%) in Measure Up 1 and 29 of 799 patients (3.6%) in Measure Up 2 and similar between treatment groups; most events were nonserious. Serious events of COVID-19 were reported in 5 patients (0.3%); 1 led to treatment discontinuation.

One adjudicated major adverse cardiovascular event (nonfatal stroke) was reported in a patient in their 60s with uncontrolled hypertension who was taking upadacitinib 15 mg, which was classified as serious, deemed unrelated to the study drug, and resulted in discontinuation of study treatment. Two adjudicated venous thromboembolic events were reported: 1 case of deep vein thrombosis (grade 4 in severity) in a patient in their 40s taking upadacitinib 15 mg with a previous history of deep vein thrombosis, and 1 pulmonary embolism (grade 3 in severity) related to COVID-19 diagnosis in a patient in their 70s taking upadacitinib 30 mg—both events were deemed serious and unrelated to the study treatment by the investigator, and both patients discontinued study treatment.

The EAER of malignant neoplasm was 0.6/100 PYs with upadacitinib 15 mg and 0.9/100 PYs with upadacitinib 30 mg. Nonmelanoma skin cancer (NMSC) was the most reported malignant neoplasm in both treatment groups. Except for breast cancer in 2 patients, other types of cancers were reported in a single patient. Among non-NMSC cancers, 3 of 7 occurred within 3 months of study drug initiation (anal cancer, breast cancer, and gastric cancer). A case of kidney cancer had clinical findings (kidney mass and hematuria) at study entry indicating that the cancer was present at the time of randomization.

In both studies, the most frequently reported treatment-emergent AEs (≥5% in any treatment group) were acne, cough, headache, herpes zoster, oral herpes, urinary tract infection, upper respiratory tract infection, nasopharyngitis, atopic dermatitis, and elevation in blood creatine phosphokinase level (eTable 3 in Supplement 1). Acne events were nonserious, and treatment discontinuation was rare (1 of 1609 [0.1%]). Most acne events involved the face and consisted primarily of inflammatory papules, pustules, and/or comedones. Acne required no intervention in 34 of 84 (40.5%) and 61 of 131 (46.6%) patients in the upadacitinib 15-mg and 30-mg groups, respectively; most remaining cases were managed with topical therapies. The most common risk factors were history of acne and/or family history of acne.

Adverse events of hepatic disorder (most were transaminase elevations), anemia, lymphopenia, and elevations in creatine phosphokinase were reported more frequently in upadacitinib 30-mg vs upadacitinib 15-mg groups (Table 3). These laboratory-related AEs were generally transient, mild to moderate, and asymptomatic. Grade 3 to 4 anemia, lymphopenia, neutropenia, and elevated aspartate aminotransferase, alanine aminotransferase, and creatine phosphokinase levels were infrequent across all treatment groups (eTable 4 in Supplement 1); the frequency of these laboratory abnormalities was higher in the upadacitinib 30-mg group vs the 15-mg group. Changes in laboratory parameters occurred by weeks 8 to 12 and were stable thereafter (eFigure 14 in Supplement 1). Treatment discontinuations due to laboratory-related toxic effects were infrequent.

In Measure Up 1 and Measure Up 2, both doses of upadacitinib maintained efficacy responses achieved at week 16 (primary end point)¹⁰ through week 52 for several measures of AD disease activity (including vIGA-AD 0/1, vIGA-AD 0, and EASI-75/90/100), patient-reported itch (WP-NRS improvement ≥4, WP-NRS 0/1), and patient-reported quality of life (DLQI, HADS, and ADerm-IS Sleep, Daily Activities, and Emotional State). Collectively, these results indicate that AD treatment with upadacitinib led to robust and comprehensive long-term disease control. Placebo-treated patients who were rerandomized at week 16 to upadacitinib achieved similar response trends through study week 52 to those who received upadacitinib from day 1, confirming the findings from the double-blind period. While upadacitinib 15 mg achieved and maintained high levels of efficacy, there was greater relative benefit with the 30-mg dose. Patients receiving upadacitinib 30 mg consistently reached numerically greater response rates and higher degrees of improvement than did patients receiving upadacitinib 15 mg for all outcome measures assessed through week 52. The numerically better outcomes with upadacitinib 30 mg through week 52 are more apparent when using more stringent thresholds of disease activity (vIGA 0, EASI-90/100).

No new safety risks were observed beyond those noted in the 16-week treatment period,¹⁰ and no new safety risks were identified for upadacitinib compared with the rheumatoid arthritis and psoriatic arthritis studies.⁶ The EAERs observed in Measure Up 1 and Measure Up 2 through 52 weeks were generally comparable to those observed at week 16 and generally similar to or lower than the rates reported following upadacitinib treatment in patients with rheumatoid arthritis.¹⁵ While there was a higher rate of safety events with upadacitinib 30 mg, these events were mostly mild to moderate in severity and infrequently led to treatment discontinuation. The risk profiles for both doses are generally comparable. A few events, however, such as serious infections, herpes zoster, and laboratory-related toxic effects were reported more frequently with upadacitinib 30 mg vs 15 mg. Adjudicated major adverse cardiovascular events, adjudicated venous thromboembolism, and deaths were infrequently reported in the AD studies. Except for NMSC, no specific type or pattern of malignant neoplasms was observed. Many of the malignant neoplasms excluding NMSC were either diagnosed within a short period of time (<3 months) from the first dose of study drug or had physical findings at baseline. The safety profile of upadacitinib was similar between adolescents and the overall population. There were no reports of malignant neoplasm, adjudicated major adverse cardiovascular events, adjudicated venous thromboembolic events, or deaths in adolescent patients.

Altogether, while longer-term treatment of moderate to severe AD with upadacitinib (both 15-mg and 30-mg doses) has a favorable benefit-risk profile, upadacitinib 30 mg may provide added benefit for patients with higher disease burdens that may require more rapid or more complete response to treatment.

While 52-week results are reported here, these studies will follow patients through 260 weeks; longer-term data will be valuable for evaluating the efficacy and safety of upadacitinib for the chronic disease of atopic dermatitis. Because of the predominance of White patients in the study populations, additional studies in underrepresented populations may be needed. Although not a limitation of these studies, many patients use systemic treatments in combination with topical treatments rather than as monotherapy; this practice was evaluated in a separate study of upadacitinib in atopic dermatitis (the AD Up study).¹⁶

In this analysis of follow-up data from the ongoing phase 3 Measure Up 1 and Measure Up 2 randomized clinical trials, results through 52 weeks demonstrated the maintenance of efficacy and an acceptable longer-term safety profile of upadacitinib monotherapy in adolescents and adults with moderate to severe AD.

Accepted for Publication: December 29, 2021.

Published Online: March 9, 2022. doi:10.1001/jamadermatol.2022.0029

Correction: This article was corrected on May 18, 2022, to fix an omitted footnote in eFigure 9 of Supplement 1.

Open Access: This is an open access article distributed under the terms of the CC-BY-NC-ND License. © 2022 Simpson EL et al. JAMA Dermatology.

Corresponding Author: Emma Guttman-Yassky, MD, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, Box 1047, New York, NY 10029-6574 (emma.guttman@mountsinai.org).

Author Contributions: Drs Simpson and Guttman-Yassky had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Simpson, Katoh, Calimlim, Wegzyn, Hu, M. Liu, A. Chu, Guttman-Yassky.

Acquisition, analysis, or interpretation of data: Papp, Blauvelt, C. Chu, Hong, Katoh, Calimlim, Thyssen, Chiou, Bissonnette, Stein Gold, Wegzyn, Hu, M. Liu, J. Liu, Tenorio, A. Chu, Guttman-Yassky.

Drafting of the manuscript: Hong, Katoh, Wegzyn, Hu, M. Liu, J. Liu, Tenorio.

Critical revision of the manuscript for important intellectual content: Simpson, Papp, Blauvelt, C. Chu, Hong, Katoh, Calimlim, Thyssen, Chiou, Bissonnette, Stein Gold, Wegzyn, M. Liu, J. Liu, Tenorio, A. Chu, Guttman-Yassky.

Statistical analysis: Simpson, Hu, M. Liu, A. Chu.

Obtained funding: Hong, Katoh.

Administrative, technical, or material support: Simpson, C. Chu, Chiou, Wegzyn.

Supervision: Katoh, Tenorio, A. Chu, Guttman-Yassky.

Conflicts of Interest Disclosures: Dr Simpson reported receiving grants from AbbVie, Amgen, Arcutis, Corevita, Dermira, Eli Lilly, Incyte, Kyowa Hakko Kirin, Leo Pharmaceuticals, Merck, Novartis, Pfizer, Regeneron, Sanofi Genzyme, and TARGET-DERM and personal fees from AbbVie, Amgen, Arena Pharmaceuticals, Aslan Pharma, Boston Consulting Group, Collective Acumen, Dermira, Eli Lilly, Evidera, Excerpta Medica, Forte Bio RX, Galderma, GlaxoSmithKline, Incyte, Janssen, Kyowa Kirin Pharmaceutical Development, Leo Pharm, Medscape LLC, Pfizer, Physicians World LLC, Regeneron, Sanofi Genzyme, Trevi Therapeutics, and WebMD outside the submitted work. Dr Papp reported receiving grants, personal fees, and nonfinancial support from AbbVie during the conduct of the study; and receiving grants from Amgen, Boehringer Ingelheim, Dermira, Janssen, Kyowa Kirin, Leo Pharma, Novartis, Pfizer, Incyte, Arcutis, Akros, Anacor, Avillion, Bausch Health, Baxalta, Bristol Myers Squibb, Eli Lilly, Galapagos, Galderma, Gilead, Merck, Regeneron, and Sun Pharma and personal fees from Can-Fite, Dice Pharmaceuticals, Evelo, Meiji Seika Pharma, Mitsubishi Tanabe, Sanofi Genzyme, and Takeda outside the submitted work. Dr Blauvelt reported receiving personal fees from AbbVie as a scientific consultant and other from AbbVie (company has received funds to perform clinical trial work) during the conduct of the study; and having served as a scientific adviser for (received honoraria from) Abcentra, Aligos Therapeutics, Almirall, Arcutis, Arena, Aslan, Athenex, Boehringer Ingelheim, Bristol Myers Squibb, Dermavant, EcoR1, Eli Lilly and Company, Evommune, Forte, Galderma, Incyte, Janssen, Landos, Leo, Novartis, Pfizer, RAPT, Regeneron, Sanofi Genzyme, Sun Pharma, UCB Pharma, and Vibliome Therapeutics, and having acted as a clinical study investigator for (institution has received clinical study funds from) Amgen, Arcutis, Athenex, Boehringer Ingelheim, Bristol Myers Squibb, Dermavant, Eli Lilly and Company, Galderma, Incyte, Janssen, Leo, Novartis, Pfizer, Regeneron, Sun Pharma, and UCB Pharma outside the submitted work. Dr C. Chu reported receiving personal fees from AbbVie (investigator, speaker fee, and consultant fee) during the conduct of the study; and serving as an investigator for AbbVie, Dermira, Lilly, Novartis, Oneness Biotech, Pfizer, Regeneron, Roche, Sanofi, and United BioPharma; receiving personal fees from AbbVie, Janssen, Lilly, Mylan, Novartis, Pfizer, Roche, Sanofi, United BioPharma, and Viatris; and receiving grants from Novartis, Regeneron, and Sanofi outside the submitted work. Dr Hong reported receiving grants, fees, and nonfinancial support from AbbVie, Pfizer, Leo, and Sanofi Genzyme and receiving grants from Incyte, Dermavant, and Eli Lilly outside the submitted work. Dr Katoh reported receiving grants and personal fees from AbbVie during the conduct of the study; and receiving grants from Maruho, Eli Lilly Japan, Mitsubishi Tanabe Pharma, Sanofi, Kyowa Kirin, Sun Pharma, Taiho Pharmaceutical, and Leo Pharma, and personal fees from Sanofi, Maruho, Eli Lilly Japan, Taiho Pharmaceutical, Jansen Pharma, Mitsubishi Tanabe Pharma, Kyowa Kirin, Celgene Japan, and Leo Pharma outside the submitted work. Dr Thyssen reported receiving personal fees from AbbVie for speaking and advising during the conduct of the study; and receiving grants from Regeneron, Sanofi Genzyme, and Pfizer and personal fees from Leo Pharma, Lilly, OM-85, Almirall, Asana, and Arena outside the submitted work. Dr Chiou reported other from AbbVie (clinical study investigator and consultant) during the conduct of the study; serving as a clinical study investigator for Sanofi, Dermira, Eli Lilly, and Regeneron; personal fees for medical advisory boards from Pfizer and Trevi Therapeutics outside the submitted work. Dr Bissonnette reported consulting for AbbVie, EMD Serono, Evidera, BlueFin, Kyowa Kirin, and Inmagene Bio; receiving grants and other (consultation and advisory board) from Arena, Eli Lilly, Sanofi Genzyme, Incyte, and LEO Pharma; receiving grants and other (advisory board) from Arcutis and Dermavant; receiving grants and other (consultation) from Boehringer Ingelheim, Cara Therapeutics, and Target RWE; serving on advisory boards for Galderma and GlaxoSmithKline; being a shareholder of Innovaderm; receiving grants from Bellus, Kiniksa Pharmaceuticals, Novan, Pfizer, Relaxer Therapeutics, Regeneron, and Vyne Therapeutics; and receiving grants and other from RAPT Therapeutics outside the submitted work. Dr Stein Gold reported receiving grants and personal fees from AbbVie, Pfizer, Incyte, Arcutis, and Dermavant; grants from Lilly; and personal fees from Regeneron and Sanofi during the conduct of the study. Dr Hu reported receiving personal fees from AbbVie (salary) outside the submitted work. Dr J. Liu reported being an employee of AbbVie Inc and receiving payment and holding stocks. Dr Tenorio reported being an employee of AbbVie. Dr A. Chu reported receiving personal fees from AbbVie (employment and stock options) during the conduct of the study and outside the submitted work. Dr Guttman-Yassky reported receiving grants from AbbVie during the conduct of the study. No other disclosures were reported.

Funding/Support: This study was by funded by AbbVie Inc. AbbVie funded the research for these studies and provided writing support for this manuscript. Medical writing assistance, funded by AbbVie, was provided by Caroline Walsh Cazares, PhD, Alicia Salinero, PhD, and Kersten Reich, MPH, CMPP, of JB Ashtin.

Role of the Funder/Sponsor: AbbVie participated in the study design; study research; collection, analysis, and interpretation of data; and writing, reviewing, and approval of this manuscript for submission.

Data Sharing Statement: See Supplement 2.

Additional Information: AbbVie and the authors thank all study investigators for their contributions and the patients who participated in these studies. The authors would like to acknowledge Yihua Gu, MS (AbbVie), for her contributions during the initial stages of manuscript development.