P108 Acne as an adverse effect of upadacitinib treatment for atopic dermatitis in adults and adolescents: a systematic review of short-term analysis

Abstract Atopic dermatitis (AD) is a chronic, recurrent, immune-mediated inflammatory skin disease characterized by eczema and intense itching. There are many drugs used in patients with AD, but none of them is preferential. In this context, upadacitinib, an oral Janus kinase inhibitor, has been suggested for AD treatment. However, acne has been described as a potential adverse effect of this drug. We aim to compare the incidence of acne among patients treated with upadacitinib and placebo through randomized clinical trials (RCTs) in adolescents and adults with moderate-to-severe AD. The PubMed, Scopus and Cochrane databases were used to search for RCTs comparing upadacitinib and placebo in adolescents and adults with moderate-to-severe AD. The outcome assessed was acne. We included four RCTs: Measure Up 1 and Measure Up 2 (together abbreviated here as MUp), AD Up (ADUp) and Rising Up (RUp). These involved 2855 patients allocated to receive placebo, upadacitinib 15 mg or upadacitinib 30 mg. Of these patients, 269 had acne as an adverse event. The follow-up period was 16 weeks. Acne was predominant in the upadacitinib 30-mg group (19.8% in RUp, and 15.2% in MUp + ADUp). Patients aged 18–40 years were the most affected by acne, especially those in the upadacitinib 30-mg group. The body area most affected by acne was the face in all groups and studies (placebo: 80% in RUp and 89.5% in MUp + ADUp; upadacitinib 15 mg: 83.3% in RUp and 96.4% in MUp + ADUp; upadacitinib 30 mg: 94.4% in RUp and 96.2% in MUp + ADUp). The most common presentation of acne was as inflammatory papules (placebo: 100% in RUp and 84.2% in MUp + ADUp; upadacitinib 15 mg: 83.3% in RUp and 91.7% in MUp + ADUp; upadacitinib 30 mg: 88.9% in RUp and 8.4% in MUp + ADUp). There were two episodes of medication discontinuation due to acne, each in the RUp study in the upadacitinib 15-mg and 30-mg groups. Our ana­lysis suggest that acne as an adverse effect was more intense in the upadacitinib 30-mg group in all studies. Also, the face was the most common site of manifestation, and the most common presentation was as papules.