From the FDA Drug Label
Upadacitinib treatment was associated with dose-related increases in total cholesterol, triglycerides and LDL cholesterol. Lipid Elevations In controlled trials, for up to 12/14 weeks, changes from baseline in lipid parameters in patients treated with RINVOQ 15 mg and upadacitinib 30 mg, respectively, are summarized below: Mean LDL cholesterol increased by 14.81 mg/dL and 17.17 mg/dL. Mean HDL cholesterol increased by 8.16 mg/dL and 9.01 mg/dL. The mean LDL/HDL ratio remained stable. Mean triglycerides increased by 13.55 mg/dL and 14. 44 mg/dL.
The FDA drug label does not provide information on the management of a patient with autoimmune hypothyroidism and hyperlipidemia, currently controlled on Upadacitinib, or the suitability of shifting to Tralokinumab 1.
From the Research
Management of Autoimmune Hypothyroidism and Hyperlipidemia
- The patient is currently controlled on Upadacitinib (JAK inhibitor) after failing Dupixent (Dupilumab) 2, 3, 4.
- There is no direct evidence to suggest that shifting to Tralokinumab would be a suitable option for managing autoimmune hypothyroidism and hyperlipidemia.
- However, a study suggests that switching from Dupilumab to Tralokinumab or Janus Kinase Inhibitors (JAKi) may be considered in cases of ocular and/or facial adverse events in patients with Atopic Dermatitis 5.
- Another study compared the efficacy and safety of Upadacitinib versus Dupilumab treatment for moderate-to-severe Atopic Dermatitis in four body regions, and found that Upadacitinib provided higher rates of rapid, sustained efficacy 6.
Considerations for Shifting to Tralokinumab
- A retrospective study found that Janus Kinase Inhibitors (JAKi) appear to be more efficient than Tralokinumab in managing Dupilumab-induced adverse events, but both strategies may fail to control Atopic Dermatitis 5.
- The safety and efficacy of Tralokinumab in patients with autoimmune hypothyroidism and hyperlipidemia are not well established.
- The decision to shift to Tralokinumab should be based on individual patient needs and medical history, and should be made in consultation with a healthcare professional.
Efficacy of Upadacitinib
- Upadacitinib has demonstrated high and rapid rates of efficacy in adolescent and adult patients with moderate-to-severe Atopic Dermatitis, as assessed by the Eczema Area and Severity Index (EASI) 2, 4, 6.
- Upadacitinib has been shown to provide higher rates of rapid, sustained efficacy compared to Dupilumab in four body regions, including the head and neck, trunk, upper limbs, and lower limbs 6.