Atopic Dermatitis
Conditions
Keywords
Atopic Dermatitis, Upadacitinib
Brief summary
The objective of this study is to assess the efficacy and safety of upadacitinib combined with topical corticosteroids (TCS) for the treatment of adolescent and adult participants with moderate to severe atopic dermatitis (AD) who are candidates for systemic therapy.
Detailed description
This study includes a 35-day screening period, a 16-week double-blind period, a blinded extension period up to Week 260, a blinded Long-term Extension (LTE) Period after Week 260 to Week 524, and a 30-day follow-up visit. Participants who meet eligibility criteria in the Main Study will be randomly assigned in a 1:1:1 ratio to receive upadacitinib 15 mg, upadacitinib 30 mg, or placebo once daily, in combination with topical corticosteroids. Upon completion of enrollment of 810 participants in the Main Study, a supplemental study will continue to enroll adolescent participants (Adolescent Sub-study) until a total of 180 adolescent participants are enrolled in the overall study (Main Study + Adolescent Sub-study). Approximately 1000 participants from M16-045 or M18-891 and approximately 500 participants from M16-047 will have the opportunity to enroll into the blinded Long-Term Extension (LTE) period (Week 260 - Week 524) after reaching Week 260 in their respective studies. Randomization for the Main Study will be stratified by Baseline disease severity (validated Investigator Global Assessment Scale for Atopic Dermatitis \[vIGA-AD\] score of moderate \[3\] versus severe \[4\]), by geographic region (US/Puerto Rico/Canada, Japan, China, and Other), and by age (adolescent \[ages 12 to 17\] versus adult \[ages 18 to 75\]). The separate randomization for the Adolescent Sub-study will be stratified by Baseline disease severity (moderate \[vIGA-AD 3\] versus severe \[vIGA-AD 4\]) and by geographic region (US/Puerto Rico/Canada and Other). At Week 16 of both the Main Study and the Adolescent Sub-study, participants in the placebo group will be re-randomized in a 1:1 ratio to receive daily oral doses of upadacitinib 30 mg or upadacitinib 15 mg in the blinded extension period, and participants originally randomized to upadacitinib will continue upadacitinib in the extension period at the same dose. For the Main Study, the re-randomization will be stratified by Eczema Area and Severity Index (EASI) 50 responder status (Yes/No), by geographic region (US/Puerto Rico/Canada, Japan, China, and Other) and by age (adolescent \[ages 12 to 17\] versus adult \[ages 18 to 75\]). For the Adolescent Sub-study, the re-randomization will be stratified by EASI 50 responder (Yes/No) and by geographic region (US/Puerto Rico/Canada and Other). Starting at Week 4, rescue treatment for AD may be provided at the discretion of the investigator if medically necessary The Primary Analysis for the Main Study will be conducted after all ongoing participants have completed Week 16. In addition, a Primary Analysis for the adolescent population (including the adolescent participants from the Main Study and the Adolescent Sub-study) will be conducted after all ongoing adolescent participants have completed Week 16.
Interventions
Tablets taken orally once a day
Tablets taken orally once a day
Topical corticosteroids will be applied in a stepdown regimen, starting with medium potency once daily to areas with active lesions until lesions are clear or almost clear, or for 3 consecutive weeks, whichever is shorter; then low potency topical corticosteroids once daily. If lesions return or persist, this step-down approach will be repeated until lesion resolution or evidence of local or systemic topical corticosteroids toxicity. Recommended TCS include triamcinolone acetonide 0.1% cream or fluocinolone acetonide 0.025% ointment as medium potency topical corticosteroids and hydrocortisone 1% cream as low potency topical corticosteroid.
Sponsors
Study design
Eligibility
Inclusion criteria
* Body weight of ≥ 40 kg at Baseline Visit for participants ≥ 12 and \< 18 years of age * Chronic atopic dermatitis (AD) with onset of symptoms at least 3 years prior to Baseline Visit and subject meets Hanifin and Rajka criteria. * Active moderate to severe atopic dermatitis defined by Eczema Area and Severity Index (EASI) ≥ 16, validated Investigator's Global Assessment (vIGA) ≥ 3, ≥ 10% of body surface area (BSA) with AD involvement, and weekly average of daily Worst Pruritus numerical rating scale (NRS) ≥ 4. * Subject has applied a topical emollient (moisturizer) twice daily for at least 7 days before the Baseline Visit. * Documented history of inadequate response to topical corticosteroids or topical calcineurin inhibitor OR documented systemic treatment for AD within 6 months prior to Baseline Visit
Exclusion criteria
* Prior exposure to any Janus kinase (JAK) inhibitor * Unable or unwilling to discontinue current atopic dermatitis (AD) treatments prior to the study * Requirement of prohibited medications during the study * Other active skin diseases or skin infections requiring systemic treatment or would interfere with appropriate assessment of atopic dermatitis lesions * Female subject who is pregnant, breastfeeding, or considering pregnancy during the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Main Study: Percentage of Participants Achieving at Least a 75% Reduction in Eczema Area and Severity Index Score (EASI 75) From Baseline at Week 16 | Baseline and Week 16 | EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema). The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease. |
| Main Study: Percentage of Participants Achieving Validated Investigator Global Assessment for Atopic Dermatitis (vIGA-AD) of 0 or 1 With a Reduction From Baseline of ≥ 2 Points at Week 16 | Baseline and Week 16 | The vIGA-AD is a validated assessment instrument to rate the severity of atopic dermatitis globally, based on the following scale: * 0 - Clear: No inflammatory signs of AD; * 1 - Almost clear: Barely perceptible erythema, induration/papulation and/or lichenification; * 2 - Mild: Slight but definite erythema, induration/papulation and/or minimal lichenification. No oozing or crusting; * 3 - Moderate: Clearly perceptible erythema, induration/papulation and/or lichenification, oozing or crusting may be present; * 4 - Severe: Marked erythema, induration/papulation and/or lichenification; Oozing or crusting may be present. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Main Study: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus NRS at Week 4 | Baseline (last available rolling average before the first dose of study drug) and Week 4 | Participants were asked to rate itch (pruritus) intensity at its worst during the past 24 hours on a daily basis using an 11-point scale from 0 (no itch) to 10 (worst imaginable itch). Pruritus NRS was analyzed based on weekly rolling averages of daily scores. |
| Main Study: Percentage of Participants Achieving an EASI 75 Response at Week 4 | Baseline and Week 4 | EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema). The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease. An EASI 75 response is defined as at least a 75% reduction (improvement) from Baseline in EASI score. |
| Main Study: Percentage of Participants Achieving an EASI 75 Response at Week 2 | Baseline and Week 2 | EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema). The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease. An EASI 75 response is defined as at least a 75% reduction (improvement) from Baseline in EASI score. |
| Main Study: Percentage of Participants Achieving an EASI 90 Response at Week 4 | Baseline and Week 4 | EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/ neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema). The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease. |
| Main Study: Percentage of Participants Achieving a 100% Reduction From Baseline in EASI Score (EASI 100) at Week 16 | Baseline and Week 16 | EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored from 0 \[none\], to 3 \[severe\]) for redness, thickness, scratching, and lichenification. The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease. The percentage of participants with an EASI 100 response at Week 16 was pre-specified as a ranked secondary endpoint for participants in the Upadacitinib 30 mg + Topical Corticosteroids group versus Placebo + Topical Corticosteroids group only. |
| Main Study: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus NRS at Week 1 | Baseline (last available rolling average before the first dose of study drug) and Week 1 | Participants were asked to rate itch (pruritus) intensity at its worst during the past 24 hours on a daily basis using an 11-point scale from 0 (no itch) to 10 (worst imaginable itch). Pruritus NRS was analyzed based on weekly rolling averages of daily scores. |
| Main Study: Percent Change From Baseline in Worst Pruritus NRS at Week 16 | Baseline (last available rolling average before the first dose of study drug) and Week 16 | Participants were asked to rate itch (pruritus) intensity at its worst during the past 24 hours on a daily basis using an 11-point scale from 0 (no itch) to 10 (worst imaginable itch). Pruritus NRS was analyzed based on weekly rolling averages of daily scores. A negative change from Baseline indicates improvement. |
| Main Study: Percent Change From Baseline in EASI Score at Week 16 | Baseline and Week 16 | EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1)\] moderate \[2\], or severe \[3\]) for Redness (erythema, inflammation), Thickness (induration, papulation, swelling - acute eczema), Scratching (excoriation), and Lichenification (lined skin, prurigo nodules - chronic eczema). The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease; a negative change from Baseline indicates improvement. |
| Adolescents: Percentage of Participants Achieving an EASI 75 Response at Week 16 | Baseline and Week 16 | EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema). The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease. An EASI 75 response is defined as at least a 75% reduction (improvement) from Baseline in EASI score. |
| Adolescents: Percentage of Participants Achieving a vIGA-AD of 0 or 1 With a Reduction From Baseline of ≥ 2 Points at Week 16 | Baseline and Week 16 | The vIGA-AD is a validated assessment instrument to rate the severity of atopic dermatitis globally, based on the following scale: * 0 - Clear: No signs of AD; * 1 - Almost clear: Barely perceptible erythema, induration/papulation and/or lichenification; * 2 - Mild: Slight but definite erythema, induration/papulation and/or minimal lichenification. No oozing or crusting; * 3 - Moderate: Clearly perceptible erythema, induration/papulation and/or lichenification, possible oozing or crusting; * 4 - Severe: Marked erythema, induration/papulation and/or lichenification; possible oozing or crusting. |
| Main Study: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus Numerical Rating Scale (NRS) at Week 16 | Baseline (last available rolling average before the first dose of study drug) and Week 16 | Participants were asked to rate itch (pruritus) intensity at its worst during the past 24 hours on a daily basis using an 11-point scale from 0 (no itch) to 10 (worst imaginable itch). Pruritus NRS was analyzed based on weekly rolling averages of daily scores. |
| Adolescents: Percentage of Participants Achieving an EASI 90 Response at Week 16 | Baseline and Week 16 | EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema). The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease. An EASI 90 response is defined as at least a 90% reduction (improvement) from Baseline in EASI score. |
| Adolescents: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus NRS at Week 4 | Baseline (last available rolling average before the first dose of study drug) and Week 4 | Participants were asked to rate itch (pruritus) intensity at its worst during the past 24 hours on a daily basis using an 11-point scale from 0 (no itch) to 10 (worst imaginable itch). Worst pruritus NRS was analyzed based on weekly rolling averages of daily scores. |
| Adolescents: Percentage of Participants Achieving an EASI 75 Response at Week 4 | Baseline and Week 4 | EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema). The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease. An EASI 75 response is defined as at least a 75% reduction (improvement) from Baseline in EASI score. |
| Adolescents: Percentage of Participants Achieving an EASI 75 Response at Week 2 | Baseline and Week 2 | EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema). The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease. An EASI 75 response is defined as at least a 75% reduction (improvement) from Baseline in EASI score. |
| Adolescents: Percentage of Participants Achieving an EASI 90 Response at Week 4 | Baseline and Week 4 | EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema). The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease. An EASI 90 response is defined as at least a 90% reduction (improvement) from Baseline in EASI score. |
| Adolescents: Percentage of Participants Achieving an EASI 100 Response at Week 16 | Baseline and Week 16 | EASI is used to measure the extent and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. and the severity score is calculated as the sum of the intensity scores (scored from 0 \[none\], to 3 \[severe\]) for redness, thickness, scratching, and lichenification. The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease. An EASI 100 response is defined as a 100% reduction (improvement) from Baseline in EASI score. The percentage of participants with an EASI 100 response at Week 16 was pre-specified as a secondary endpoint for participants in the Upadacitinib 30 mg + TCS group versus Placebo + TCS group only. |
| Adolescents: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus NRS at Week 1 | Baseline (last available rolling average before the first dose of study drug) and Week 1 | Participants were asked to rate itch (pruritus) intensity at its worst during the past 24 hours on a daily basis using an 11-point scale from 0 (no itch) to 10 (worst imaginable itch). Worst pruritus NRS was analyzed based on weekly rolling averages of daily scores. |
| Adolescents: Percent Change From Baseline in Worst Pruritus NRS at Week 16 | Baseline (last available rolling average before the first dose of study drug) and Week 16 | Participants were asked to rate itch (pruritus) intensity at its worst during the past 24 hours on a daily basis using an 11-point scale from 0 (no itch) to 10 (worst imaginable itch). Pruritus NRS was analyzed based on weekly rolling averages of daily scores. A negative change from Baseline indicates improvement. |
| Adolescents: Percent Change From Baseline in EASI Score at Week 16 | Baseline and Week 16 | EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1)\] moderate \[2\], or severe \[3\]) for Redness (erythema, inflammation), Thickness (induration, papulation, swelling - acute eczema), Scratching (excoriation), and Lichenification (lined skin, prurigo nodules - chronic eczema). The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease; a negative change from Baseline indicates improvement. |
| Adolescents: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus NRS at Week 16 | Baseline (last available rolling average before the first dose of study drug) and Week 16 | Participants were asked to rate itch (pruritus) intensity at its worst during the past 24 hours on a daily basis using an 11-point scale from 0 (no itch) to 10 (worst imaginable itch). Worst pruritus NRS was analyzed based on weekly rolling averages of daily scores. |
| Main Study: Percentage of Participants Achieving a 90% Reduction From Baseline in EASI Score (EASI 90) at Week 16 | Baseline and Week 16 | EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/ neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema). The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease. |
Countries
Australia, Austria, Belgium, Canada, China, Czechia, France, Germany, Greece, Hong Kong, Hungary, Ireland, Israel, Italy, Japan, Netherlands, New Zealand, Norway, Puerto Rico, Slovakia, Spain, Sweden, United Kingdom, United States
Participant flow
Recruitment details
Participants were enrolled at 171 clinical sites in 22 countries in the Asia-Pacific region, Europe, Middle East, North America, and Oceania. The study included a 16-week double-blind treatment period followed by a blinded extension period (ongoing). The first 810 adults and adolescents enrolled constituted the Main Study; additional adolescents were enrolled in the Adolescent Substudy to ensure enrollment of a total of 180 adolescent participants overall. Results are reported up to Week 16.
Pre-assignment details
Participants were randomized equally into 1 of 3 treatment groups, stratified by disease severity (validated Investigator Global Assessment Scale for Atopic Dermatitis \[vIGA-AD\] moderate \[3\] vs severe \[4\]), geographic region (US/Puerto Rico/Canada, Japan, China, and Other), and age (adolescent \[ages 12 to 17\] vs adult \[ages 18 to 75\]). Randomization for the adolescent substudy was stratified by disease severity (vIGA-AD 3 vs vIGA-AD 4) and geographic region (US/Puerto Rico/Canada vs Other).
Participants by arm
| Arm | Count |
|---|---|
| Adults: Placebo + Topical Corticosteroids Participants ≥ 18 years old received placebo orally once a day (QD) and topical corticosteroids following a step-down regimen for 16 weeks in the double-blind treatment period. | 264 |
| Adults: Upadacitinib 15 mg + Topical Corticosteroids Participants ≥ 18 years old received upadacitinib 15 mg orally once a day and topical corticosteroids following a step-down regimen for 16 weeks in the double-blind treatment period. | 261 |
| Adults: Upadacitinib 30 mg + Topical Corticosteroids Participants ≥ 18 years old received upadacitinib 30 mg orally once a day and topical corticosteroids following a step-down regimen for 16 weeks in the double-blind treatment period. | 260 |
| Adolescents: Placebo + Topical Corticosteroids Adolescent participants (12 - 17 years old) received placebo orally once a day and topical corticosteroids following a step-down regimen for 16 weeks in the double-blind treatment period. | 63 |
| Adolescents: Upadacitinib 15 mg + Topical Corticosteroids Adolescent participants received upadacitinib 15 mg orally once a day and topical corticosteroids following a step-down regimen for 16 weeks in the double-blind treatment period. | 60 |
| Adolescents: Upadacitinib 30 mg + Topical Corticosteroids Adolescent participants received upadacitinib 30 mg orally once a day and topical corticosteroids following a step-down regimen for 16 weeks in the double-blind treatment period. | 60 |
| Total | 968 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 | FG004 | FG005 |
|---|---|---|---|---|---|---|---|
| Overall Study | Adverse Event | 3 | 1 | 1 | 0 | 1 | 0 |
| Overall Study | Lost to Follow-up | 3 | 2 | 2 | 2 | 1 | 0 |
| Overall Study | Ongoing at Time of Analysis | 5 | 3 | 2 | 1 | 0 | 0 |
| Overall Study | Other | 3 | 1 | 3 | 0 | 0 | 0 |
| Overall Study | Withdrawal by Subject | 6 | 5 | 2 | 1 | 0 | 0 |
Baseline characteristics
| Characteristic | Adults: Placebo + Topical Corticosteroids | Adults: Upadacitinib 15 mg + Topical Corticosteroids | Adults: Upadacitinib 30 mg + Topical Corticosteroids | Adolescents: Placebo + Topical Corticosteroids | Adolescents: Upadacitinib 15 mg + Topical Corticosteroids | Adolescents: Upadacitinib 30 mg + Topical Corticosteroids | Total |
|---|---|---|---|---|---|---|---|
| Age, Continuous | 37.2 years STANDARD_DEVIATION 14.08 | 35.0 years STANDARD_DEVIATION 13.29 | 38.3 years STANDARD_DEVIATION 14.82 | 15.1 years STANDARD_DEVIATION 1.85 | 15.4 years STANDARD_DEVIATION 1.65 | 15.3 years STANDARD_DEVIATION 1.86 | 32.8 years STANDARD_DEVIATION 15.29 |
| Age, Customized 12 - 14 years | 0 Participants | 0 Participants | 0 Participants | 23 Participants | 14 Participants | 21 Participants | 58 Participants |
| Age, Customized 15 - 17 years | 0 Participants | 0 Participants | 0 Participants | 40 Participants | 46 Participants | 39 Participants | 125 Participants |
| Age, Customized 18 - < 40 years | 156 Participants | 176 Participants | 158 Participants | 0 Participants | 0 Participants | 0 Participants | 490 Participants |
| Age, Customized 40 - < 65 years | 94 Participants | 80 Participants | 85 Participants | 0 Participants | 0 Participants | 0 Participants | 259 Participants |
| Age, Customized ≥ 65 years | 14 Participants | 5 Participants | 17 Participants | 0 Participants | 0 Participants | 0 Participants | 36 Participants |
| Disease Duration since Diagnosis | 25.986 years STANDARD_DEVIATION 15.565 | 24.511 years STANDARD_DEVIATION 14.0363 | 24.617 years STANDARD_DEVIATION 16.6107 | 12.315 years STANDARD_DEVIATION 4.2769 | 11.370 years STANDARD_DEVIATION 5.0674 | 12.244 years STANDARD_DEVIATION 3.9262 | 22.584 years STANDARD_DEVIATION 14.9374 |
| Eczema Area and Severity Index (EASI) Score | 30.06 score on a scale STANDARD_DEVIATION 12.86 | 29.03 score on a scale STANDARD_DEVIATION 11.925 | 29.68 score on a scale STANDARD_DEVIATION 11.993 | 30.25 score on a scale STANDARD_DEVIATION 12.105 | 29.59 score on a scale STANDARD_DEVIATION 11.683 | 28.68 score on a scale STANDARD_DEVIATION 10.143 | 29.58 score on a scale STANDARD_DEVIATION 12.082 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 15 Participants | 21 Participants | 14 Participants | 7 Participants | 8 Participants | 7 Participants | 72 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 249 Participants | 240 Participants | 246 Participants | 56 Participants | 52 Participants | 53 Participants | 896 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Geographic Region China | 16 Participants | 15 Participants | 15 Participants | 2 Participants | 2 Participants | 1 Participants | 51 Participants |
| Geographic Region Japan | 18 Participants | 16 Participants | 17 Participants | 0 Participants | 0 Participants | 0 Participants | 51 Participants |
| Geographic Region Other | 140 Participants | 140 Participants | 139 Participants | 30 Participants | 27 Participants | 28 Participants | 504 Participants |
| Geographic Region US/Puerto Rico/Canada | 90 Participants | 90 Participants | 89 Participants | 31 Participants | 31 Participants | 31 Participants | 362 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants | 2 Participants | 3 Participants | 0 Participants | 0 Participants | 0 Participants | 6 Participants |
| Race (NIH/OMB) Asian | 52 Participants | 57 Participants | 58 Participants | 14 Participants | 13 Participants | 6 Participants | 200 Participants |
| Race (NIH/OMB) Black or African American | 15 Participants | 15 Participants | 9 Participants | 5 Participants | 5 Participants | 6 Participants | 55 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 7 Participants | 1 Participants | 0 Participants | 1 Participants | 2 Participants | 11 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 3 Participants | 1 Participants | 0 Participants | 0 Participants | 0 Participants | 4 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 196 Participants | 177 Participants | 188 Participants | 44 Participants | 41 Participants | 46 Participants | 692 Participants |
| Sex: Female, Male Female | 101 Participants | 104 Participants | 95 Participants | 36 Participants | 27 Participants | 25 Participants | 388 Participants |
| Sex: Female, Male Male | 163 Participants | 157 Participants | 165 Participants | 27 Participants | 33 Participants | 35 Participants | 580 Participants |
| Study Enrollment Adolescent Substudy | 0 Participants | 0 Participants | 0 Participants | 23 Participants | 21 Participants | 23 Participants | 67 Participants |
| Study Enrollment Main Study | 264 Participants | 261 Participants | 260 Participants | 40 Participants | 39 Participants | 37 Participants | 901 Participants |
| Validated Investigator Global Assessment Scale for Atopic Dermatitis (vIGA-AD) 3 (Moderate) | 123 Participants | 124 Participants | 123 Participants | 28 Participants | 29 Participants | 29 Participants | 456 Participants |
| Validated Investigator Global Assessment Scale for Atopic Dermatitis (vIGA-AD) 4 (Severe) | 141 Participants | 137 Participants | 137 Participants | 35 Participants | 31 Participants | 31 Participants | 512 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk | EG005 affected / at risk |
|---|---|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 264 | 0 / 261 | 0 / 260 | 0 / 62 | 0 / 60 | 0 / 60 |
| other Total, other adverse events | 99 / 264 | 111 / 261 | 123 / 260 | 21 / 62 | 24 / 60 | 32 / 60 |
| serious Total, serious adverse events | 9 / 264 | 7 / 261 | 4 / 260 | 0 / 62 | 1 / 60 | 0 / 60 |
Outcome results
Main Study: Percentage of Participants Achieving at Least a 75% Reduction in Eczema Area and Severity Index Score (EASI 75) From Baseline at Week 16
EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema). The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease.
Time frame: Baseline and Week 16
Population: The intent-to-treat population for the main study (ITT\_M) includes all participants who were randomized in the main study (adults and adolescents). Non-responder imputation incorporating multiple imputation to handle missing data due to coronavirus disease 2019 pandemic (COVID-19) (NRI-C) was used.~The pre-specified primary analysis included participants enrolled in the main study only; Efficacy analyses of adolescent participants were conducted separately and are reported below.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo + Topical Corticosteroids | Main Study: Percentage of Participants Achieving at Least a 75% Reduction in Eczema Area and Severity Index Score (EASI 75) From Baseline at Week 16 | 26.4 percentage of participants |
| Upadacitinib 15 mg + Topical Corticosteroids | Main Study: Percentage of Participants Achieving at Least a 75% Reduction in Eczema Area and Severity Index Score (EASI 75) From Baseline at Week 16 | 64.6 percentage of participants |
| Upadacitinib 30 mg + Topical Corticosteroids | Main Study: Percentage of Participants Achieving at Least a 75% Reduction in Eczema Area and Severity Index Score (EASI 75) From Baseline at Week 16 | 77.1 percentage of participants |
Main Study: Percentage of Participants Achieving Validated Investigator Global Assessment for Atopic Dermatitis (vIGA-AD) of 0 or 1 With a Reduction From Baseline of ≥ 2 Points at Week 16
The vIGA-AD is a validated assessment instrument to rate the severity of atopic dermatitis globally, based on the following scale: * 0 - Clear: No inflammatory signs of AD; * 1 - Almost clear: Barely perceptible erythema, induration/papulation and/or lichenification; * 2 - Mild: Slight but definite erythema, induration/papulation and/or minimal lichenification. No oozing or crusting; * 3 - Moderate: Clearly perceptible erythema, induration/papulation and/or lichenification, oozing or crusting may be present; * 4 - Severe: Marked erythema, induration/papulation and/or lichenification; Oozing or crusting may be present.
Time frame: Baseline and Week 16
Population: Intent-to-treat population for the main study; Non-responder imputation incorporating multiple imputation to handle missing data due to COVID-19 (NRI-C) was used.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo + Topical Corticosteroids | Main Study: Percentage of Participants Achieving Validated Investigator Global Assessment for Atopic Dermatitis (vIGA-AD) of 0 or 1 With a Reduction From Baseline of ≥ 2 Points at Week 16 | 10.9 percentage of participants |
| Upadacitinib 15 mg + Topical Corticosteroids | Main Study: Percentage of Participants Achieving Validated Investigator Global Assessment for Atopic Dermatitis (vIGA-AD) of 0 or 1 With a Reduction From Baseline of ≥ 2 Points at Week 16 | 39.6 percentage of participants |
| Upadacitinib 30 mg + Topical Corticosteroids | Main Study: Percentage of Participants Achieving Validated Investigator Global Assessment for Atopic Dermatitis (vIGA-AD) of 0 or 1 With a Reduction From Baseline of ≥ 2 Points at Week 16 | 58.6 percentage of participants |
Adolescents: Percentage of Participants Achieving an EASI 100 Response at Week 16
EASI is used to measure the extent and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. and the severity score is calculated as the sum of the intensity scores (scored from 0 \[none\], to 3 \[severe\]) for redness, thickness, scratching, and lichenification. The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease. An EASI 100 response is defined as a 100% reduction (improvement) from Baseline in EASI score. The percentage of participants with an EASI 100 response at Week 16 was pre-specified as a secondary endpoint for participants in the Upadacitinib 30 mg + TCS group versus Placebo + TCS group only.
Time frame: Baseline and Week 16
Population: Intent-to-treat population for adolescents; Non-responder imputation incorporating multiple imputation to handle missing data due to COVID-19 (NRI-C) was used.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving an EASI 100 Response at Week 16 | 4.8 percentage of participants |
| Upadacitinib 15 mg + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving an EASI 100 Response at Week 16 | 13.3 percentage of participants |
| Upadacitinib 30 mg + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving an EASI 100 Response at Week 16 | 25.0 percentage of participants |
Adolescents: Percentage of Participants Achieving an EASI 75 Response at Week 16
EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema). The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease. An EASI 75 response is defined as at least a 75% reduction (improvement) from Baseline in EASI score.
Time frame: Baseline and Week 16
Population: The ITT population for adolescents (ITT\_A) consists of all adolescent participants who were randomized in the main study or the adolescent sub-study. Non-responder imputation incorporating multiple imputation to handle missing data due to COVID-19 (NRI-C) was used.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving an EASI 75 Response at Week 16 | 30.3 percentage of participants |
| Upadacitinib 15 mg + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving an EASI 75 Response at Week 16 | 63.3 percentage of participants |
| Upadacitinib 30 mg + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving an EASI 75 Response at Week 16 | 84.3 percentage of participants |
Adolescents: Percentage of Participants Achieving an EASI 75 Response at Week 2
EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema). The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease. An EASI 75 response is defined as at least a 75% reduction (improvement) from Baseline in EASI score.
Time frame: Baseline and Week 2
Population: Intent-to-treat population for adolescents; Non-responder imputation incorporating multiple imputation to handle missing data due to COVID-19 (NRI-C) was used.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving an EASI 75 Response at Week 2 | 9.5 percentage of participants |
| Upadacitinib 15 mg + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving an EASI 75 Response at Week 2 | 33.7 percentage of participants |
| Upadacitinib 30 mg + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving an EASI 75 Response at Week 2 | 51.7 percentage of participants |
Adolescents: Percentage of Participants Achieving an EASI 75 Response at Week 4
EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema). The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease. An EASI 75 response is defined as at least a 75% reduction (improvement) from Baseline in EASI score.
Time frame: Baseline and Week 4
Population: Intent-to-treat population for adolescents; Non-responder imputation incorporating multiple imputation to handle missing data due to COVID-19 (NRI-C) was used.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving an EASI 75 Response at Week 4 | 28.6 percentage of participants |
| Upadacitinib 15 mg + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving an EASI 75 Response at Week 4 | 54.9 percentage of participants |
| Upadacitinib 30 mg + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving an EASI 75 Response at Week 4 | 78.3 percentage of participants |
Adolescents: Percentage of Participants Achieving an EASI 90 Response at Week 16
EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema). The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease. An EASI 90 response is defined as at least a 90% reduction (improvement) from Baseline in EASI score.
Time frame: Baseline and Week 16
Population: Intent-to-treat population for adolescents; Non-responder imputation incorporating multiple imputation to handle missing data due to COVID-19 (NRI-C) was used.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving an EASI 90 Response at Week 16 | 20.7 percentage of participants |
| Upadacitinib 15 mg + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving an EASI 90 Response at Week 16 | 48.3 percentage of participants |
| Upadacitinib 30 mg + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving an EASI 90 Response at Week 16 | 73.6 percentage of participants |
Adolescents: Percentage of Participants Achieving an EASI 90 Response at Week 4
EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema). The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease. An EASI 90 response is defined as at least a 90% reduction (improvement) from Baseline in EASI score.
Time frame: Baseline and Week 4
Population: Intent-to-treat population for adolescents; Non-responder imputation incorporating multiple imputation to handle missing data due to COVID-19 (NRI-C) was used.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving an EASI 90 Response at Week 4 | 9.5 percentage of participants |
| Upadacitinib 15 mg + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving an EASI 90 Response at Week 4 | 34.2 percentage of participants |
| Upadacitinib 30 mg + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving an EASI 90 Response at Week 4 | 45.0 percentage of participants |
Adolescents: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus NRS at Week 1
Participants were asked to rate itch (pruritus) intensity at its worst during the past 24 hours on a daily basis using an 11-point scale from 0 (no itch) to 10 (worst imaginable itch). Worst pruritus NRS was analyzed based on weekly rolling averages of daily scores.
Time frame: Baseline (last available rolling average before the first dose of study drug) and Week 1
Population: Intent-to-treat population for adolescents with Worst Pruritus NRS (weekly average) ≥ 4 at Baseline; Non-responder imputation incorporating multiple imputation to handle missing data due to COVID-19 (NRI-C) was used.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus NRS at Week 1 | 9.8 percentage of participants |
| Upadacitinib 15 mg + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus NRS at Week 1 | 8.8 percentage of participants |
| Upadacitinib 30 mg + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus NRS at Week 1 | 16.1 percentage of participants |
Adolescents: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus NRS at Week 16
Participants were asked to rate itch (pruritus) intensity at its worst during the past 24 hours on a daily basis using an 11-point scale from 0 (no itch) to 10 (worst imaginable itch). Worst pruritus NRS was analyzed based on weekly rolling averages of daily scores.
Time frame: Baseline (last available rolling average before the first dose of study drug) and Week 16
Population: Intent-to-treat population for adolescents with Worst Pruritus NRS (weekly average) ≥ 4 at Baseline; Non-responder imputation incorporating multiple imputation to handle missing data due to COVID-19 (NRI-C) was used.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus NRS at Week 16 | 21.3 percentage of participants |
| Upadacitinib 15 mg + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus NRS at Week 16 | 45.6 percentage of participants |
| Upadacitinib 30 mg + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus NRS at Week 16 | 51.8 percentage of participants |
Adolescents: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus NRS at Week 4
Participants were asked to rate itch (pruritus) intensity at its worst during the past 24 hours on a daily basis using an 11-point scale from 0 (no itch) to 10 (worst imaginable itch). Worst pruritus NRS was analyzed based on weekly rolling averages of daily scores.
Time frame: Baseline (last available rolling average before the first dose of study drug) and Week 4
Population: Intent-to-treat population for adolescents with Worst Pruritus NRS (weekly average) ≥ 4 at Baseline; Non-responder imputation incorporating multiple imputation to handle missing data due to COVID-19 (NRI-C) was used.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus NRS at Week 4 | 23.0 percentage of participants |
| Upadacitinib 15 mg + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus NRS at Week 4 | 45.6 percentage of participants |
| Upadacitinib 30 mg + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus NRS at Week 4 | 46.4 percentage of participants |
Adolescents: Percentage of Participants Achieving a vIGA-AD of 0 or 1 With a Reduction From Baseline of ≥ 2 Points at Week 16
The vIGA-AD is a validated assessment instrument to rate the severity of atopic dermatitis globally, based on the following scale: * 0 - Clear: No signs of AD; * 1 - Almost clear: Barely perceptible erythema, induration/papulation and/or lichenification; * 2 - Mild: Slight but definite erythema, induration/papulation and/or minimal lichenification. No oozing or crusting; * 3 - Moderate: Clearly perceptible erythema, induration/papulation and/or lichenification, possible oozing or crusting; * 4 - Severe: Marked erythema, induration/papulation and/or lichenification; possible oozing or crusting.
Time frame: Baseline and Week 16
Population: The ITT population for adolescents (ITT\_A) consists of all adolescent participants who were randomized in the main study or the adolescent sub-study. Non-responder imputation incorporating multiple imputation to handle missing data due to COVID-19 (NRI-C) was used.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving a vIGA-AD of 0 or 1 With a Reduction From Baseline of ≥ 2 Points at Week 16 | 11.2 percentage of participants |
| Upadacitinib 15 mg + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving a vIGA-AD of 0 or 1 With a Reduction From Baseline of ≥ 2 Points at Week 16 | 38.3 percentage of participants |
| Upadacitinib 30 mg + Topical Corticosteroids | Adolescents: Percentage of Participants Achieving a vIGA-AD of 0 or 1 With a Reduction From Baseline of ≥ 2 Points at Week 16 | 67.4 percentage of participants |
Adolescents: Percent Change From Baseline in EASI Score at Week 16
EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1)\] moderate \[2\], or severe \[3\]) for Redness (erythema, inflammation), Thickness (induration, papulation, swelling - acute eczema), Scratching (excoriation), and Lichenification (lined skin, prurigo nodules - chronic eczema). The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease; a negative change from Baseline indicates improvement.
Time frame: Baseline and Week 16
Population: Intent-to-treat population for adolescents with non-missing Baseline and Week 16 values; missing data were handled using a mixed-effect model with repeated measurements including observed measurements at all visits, except that measurements after any rescue medication were excluded.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Placebo + Topical Corticosteroids | Adolescents: Percent Change From Baseline in EASI Score at Week 16 | -53.53 percent change |
| Upadacitinib 15 mg + Topical Corticosteroids | Adolescents: Percent Change From Baseline in EASI Score at Week 16 | -77.90 percent change |
| Upadacitinib 30 mg + Topical Corticosteroids | Adolescents: Percent Change From Baseline in EASI Score at Week 16 | -89.22 percent change |
Adolescents: Percent Change From Baseline in Worst Pruritus NRS at Week 16
Participants were asked to rate itch (pruritus) intensity at its worst during the past 24 hours on a daily basis using an 11-point scale from 0 (no itch) to 10 (worst imaginable itch). Pruritus NRS was analyzed based on weekly rolling averages of daily scores. A negative change from Baseline indicates improvement.
Time frame: Baseline (last available rolling average before the first dose of study drug) and Week 16
Population: Intent-to-treat population for adolescents with non-missing Baseline and Week 16 values; missing data were handled using a mixed-effect model with repeated measurements including observed measurements at all visits, except that measurements after any rescue medication were excluded.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Placebo + Topical Corticosteroids | Adolescents: Percent Change From Baseline in Worst Pruritus NRS at Week 16 | -32.96 percent change |
| Upadacitinib 15 mg + Topical Corticosteroids | Adolescents: Percent Change From Baseline in Worst Pruritus NRS at Week 16 | -59.34 percent change |
| Upadacitinib 30 mg + Topical Corticosteroids | Adolescents: Percent Change From Baseline in Worst Pruritus NRS at Week 16 | -49.02 percent change |
Main Study: Percentage of Participants Achieving a 100% Reduction From Baseline in EASI Score (EASI 100) at Week 16
EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored from 0 \[none\], to 3 \[severe\]) for redness, thickness, scratching, and lichenification. The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease. The percentage of participants with an EASI 100 response at Week 16 was pre-specified as a ranked secondary endpoint for participants in the Upadacitinib 30 mg + Topical Corticosteroids group versus Placebo + Topical Corticosteroids group only.
Time frame: Baseline and Week 16
Population: Intent-to-treat population for the main study; Non-responder imputation incorporating multiple imputation to handle missing data due to COVID-19 (NRI-C) was used.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo + Topical Corticosteroids | Main Study: Percentage of Participants Achieving a 100% Reduction From Baseline in EASI Score (EASI 100) at Week 16 | 1.3 percentage of participants |
| Upadacitinib 15 mg + Topical Corticosteroids | Main Study: Percentage of Participants Achieving a 100% Reduction From Baseline in EASI Score (EASI 100) at Week 16 | 12.0 percentage of participants |
| Upadacitinib 30 mg + Topical Corticosteroids | Main Study: Percentage of Participants Achieving a 100% Reduction From Baseline in EASI Score (EASI 100) at Week 16 | 22.6 percentage of participants |
Main Study: Percentage of Participants Achieving a 90% Reduction From Baseline in EASI Score (EASI 90) at Week 16
EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/ neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema). The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease.
Time frame: Baseline and Week 16
Population: Intent-to-treat population for the main study; Non-responder imputation incorporating multiple imputation to handle missing data due to COVID-19 (NRI-C) was used.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo + Topical Corticosteroids | Main Study: Percentage of Participants Achieving a 90% Reduction From Baseline in EASI Score (EASI 90) at Week 16 | 13.2 percentage of participants |
| Upadacitinib 15 mg + Topical Corticosteroids | Main Study: Percentage of Participants Achieving a 90% Reduction From Baseline in EASI Score (EASI 90) at Week 16 | 42.8 percentage of participants |
| Upadacitinib 30 mg + Topical Corticosteroids | Main Study: Percentage of Participants Achieving a 90% Reduction From Baseline in EASI Score (EASI 90) at Week 16 | 63.1 percentage of participants |
Main Study: Percentage of Participants Achieving an EASI 75 Response at Week 2
EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema). The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease. An EASI 75 response is defined as at least a 75% reduction (improvement) from Baseline in EASI score.
Time frame: Baseline and Week 2
Population: Intent-to-treat population for the main study; Non-responder imputation incorporating multiple imputation to handle missing data due to COVID-19 (NRI-C) was used.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo + Topical Corticosteroids | Main Study: Percentage of Participants Achieving an EASI 75 Response at Week 2 | 6.9 percentage of participants |
| Upadacitinib 15 mg + Topical Corticosteroids | Main Study: Percentage of Participants Achieving an EASI 75 Response at Week 2 | 31.0 percentage of participants |
| Upadacitinib 30 mg + Topical Corticosteroids | Main Study: Percentage of Participants Achieving an EASI 75 Response at Week 2 | 44.1 percentage of participants |
Main Study: Percentage of Participants Achieving an EASI 75 Response at Week 4
EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema). The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease. An EASI 75 response is defined as at least a 75% reduction (improvement) from Baseline in EASI score.
Time frame: Baseline and Week 4
Population: Intent-to-treat population for the main study; Non-responder imputation incorporating multiple imputation to handle missing data due to COVID-19 (NRI-C) was used.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo + Topical Corticosteroids | Main Study: Percentage of Participants Achieving an EASI 75 Response at Week 4 | 14.8 percentage of participants |
| Upadacitinib 15 mg + Topical Corticosteroids | Main Study: Percentage of Participants Achieving an EASI 75 Response at Week 4 | 58.7 percentage of participants |
| Upadacitinib 30 mg + Topical Corticosteroids | Main Study: Percentage of Participants Achieving an EASI 75 Response at Week 4 | 72.4 percentage of participants |
Main Study: Percentage of Participants Achieving an EASI 90 Response at Week 4
EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/ neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema). The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease.
Time frame: Baseline and Week 4
Population: Intent-to-treat population for the main study; Non-responder imputation incorporating multiple imputation to handle missing data due to COVID-19 (NRI-C) was used.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo + Topical Corticosteroids | Main Study: Percentage of Participants Achieving an EASI 90 Response at Week 4 | 4.9 percentage of participants |
| Upadacitinib 15 mg + Topical Corticosteroids | Main Study: Percentage of Participants Achieving an EASI 90 Response at Week 4 | 28.3 percentage of participants |
| Upadacitinib 30 mg + Topical Corticosteroids | Main Study: Percentage of Participants Achieving an EASI 90 Response at Week 4 | 43.8 percentage of participants |
Main Study: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus NRS at Week 1
Participants were asked to rate itch (pruritus) intensity at its worst during the past 24 hours on a daily basis using an 11-point scale from 0 (no itch) to 10 (worst imaginable itch). Pruritus NRS was analyzed based on weekly rolling averages of daily scores.
Time frame: Baseline (last available rolling average before the first dose of study drug) and Week 1
Population: Intent-to-treat population for the main study with Worst Pruritus NRS (weekly average) ≥ 4 at Baseline; Non-responder imputation incorporating multiple imputation to handle missing data due to COVID-19 (NRI-C) was used.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo + Topical Corticosteroids | Main Study: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus NRS at Week 1 | 3.1 percentage of participants |
| Upadacitinib 15 mg + Topical Corticosteroids | Main Study: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus NRS at Week 1 | 12.2 percentage of participants |
| Upadacitinib 30 mg + Topical Corticosteroids | Main Study: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus NRS at Week 1 | 19.2 percentage of participants |
Main Study: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus NRS at Week 4
Participants were asked to rate itch (pruritus) intensity at its worst during the past 24 hours on a daily basis using an 11-point scale from 0 (no itch) to 10 (worst imaginable itch). Pruritus NRS was analyzed based on weekly rolling averages of daily scores.
Time frame: Baseline (last available rolling average before the first dose of study drug) and Week 4
Population: Intent-to-treat population for the main study with Worst Pruritus NRS (weekly average) ≥ 4 at Baseline; Non-responder imputation incorporating multiple imputation to handle missing data due to COVID-19 (NRI-C) was used.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo + Topical Corticosteroids | Main Study: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus NRS at Week 4 | 15.0 percentage of participants |
| Upadacitinib 15 mg + Topical Corticosteroids | Main Study: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus NRS at Week 4 | 52.4 percentage of participants |
| Upadacitinib 30 mg + Topical Corticosteroids | Main Study: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus NRS at Week 4 | 65.6 percentage of participants |
Main Study: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus Numerical Rating Scale (NRS) at Week 16
Participants were asked to rate itch (pruritus) intensity at its worst during the past 24 hours on a daily basis using an 11-point scale from 0 (no itch) to 10 (worst imaginable itch). Pruritus NRS was analyzed based on weekly rolling averages of daily scores.
Time frame: Baseline (last available rolling average before the first dose of study drug) and Week 16
Population: Intent-to-treat population for the main study with Worst Pruritus NRS (weekly average) ≥ 4 at Baseline; Non-responder imputation incorporating multiple imputation to handle missing data due to COVID-19 (NRI-C) was used.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo + Topical Corticosteroids | Main Study: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus Numerical Rating Scale (NRS) at Week 16 | 15.0 percentage of participants |
| Upadacitinib 15 mg + Topical Corticosteroids | Main Study: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus Numerical Rating Scale (NRS) at Week 16 | 51.7 percentage of participants |
| Upadacitinib 30 mg + Topical Corticosteroids | Main Study: Percentage of Participants Achieving a Reduction of ≥ 4 Points From Baseline in Worst Pruritus Numerical Rating Scale (NRS) at Week 16 | 63.9 percentage of participants |
Main Study: Percent Change From Baseline in EASI Score at Week 16
EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1)\] moderate \[2\], or severe \[3\]) for Redness (erythema, inflammation), Thickness (induration, papulation, swelling - acute eczema), Scratching (excoriation), and Lichenification (lined skin, prurigo nodules - chronic eczema). The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease; a negative change from Baseline indicates improvement.
Time frame: Baseline and Week 16
Population: Intent-to-treat population for the main study with non-missing Baseline and Week 16 values; missing data were handled using a mixed-effect model with repeated measurements (MMRM) including observed measurements at all visits, except that measurements after any rescue medication were excluded.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Placebo + Topical Corticosteroids | Main Study: Percent Change From Baseline in EASI Score at Week 16 | -45.86 percent change |
| Upadacitinib 15 mg + Topical Corticosteroids | Main Study: Percent Change From Baseline in EASI Score at Week 16 | -77.99 percent change |
| Upadacitinib 30 mg + Topical Corticosteroids | Main Study: Percent Change From Baseline in EASI Score at Week 16 | -87.31 percent change |
Main Study: Percent Change From Baseline in Worst Pruritus NRS at Week 16
Participants were asked to rate itch (pruritus) intensity at its worst during the past 24 hours on a daily basis using an 11-point scale from 0 (no itch) to 10 (worst imaginable itch). Pruritus NRS was analyzed based on weekly rolling averages of daily scores. A negative change from Baseline indicates improvement.
Time frame: Baseline (last available rolling average before the first dose of study drug) and Week 16
Population: Intent-to-treat population for the main study with non-missing Baseline and Week 16 values; missing data were handled using a mixed-effect model with repeated measurements (MMRM) including observed measurements at all visits, except that measurements after any rescue medication were excluded.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Placebo + Topical Corticosteroids | Main Study: Percent Change From Baseline in Worst Pruritus NRS at Week 16 | -25.07 percent change |
| Upadacitinib 15 mg + Topical Corticosteroids | Main Study: Percent Change From Baseline in Worst Pruritus NRS at Week 16 | -58.14 percent change |
| Upadacitinib 30 mg + Topical Corticosteroids | Main Study: Percent Change From Baseline in Worst Pruritus NRS at Week 16 | -66.85 percent change |