From the Guidelines
Upadacitinib is a viable treatment option for moderate to severe hidradenitis suppurativa (HS), although its efficacy in this specific condition is not directly established in the provided evidence. The most recent and highest quality study available, which is focused on ulcerative colitis, suggests that upadacitinib is more efficacious compared to many other medications, except ozanimod and risankizumab, with low- to moderate-certainty evidence 1.
Key Considerations for Treatment
- The use of upadacitinib in HS would be considered off-label, as the provided studies do not directly address its efficacy in this condition.
- Given its mechanism as a JAK1 inhibitor, upadacitinib could potentially offer benefits in reducing inflammation associated with HS.
- Patients should undergo thorough evaluation, including tuberculosis screening and updating their immunization status, due to the potential increased risk of infections with JAK inhibitors.
- Common side effects of upadacitinib include upper respiratory tract infections, acne, headache, and elevated cholesterol levels, necessitating regular laboratory monitoring.
Clinical Decision Making
- In clinical practice, the decision to use upadacitinib for HS would depend on the patient's previous response to conventional therapies, the severity of their condition, and their individual risk profile.
- It is crucial to weigh the potential benefits of upadacitinib against its risks, particularly in patients with a history of blood clots or those who are pregnant, where it is contraindicated.
- The lack of direct evidence supporting upadacitinib's use in HS means that treatment guidelines from dermatological societies, such as those from the British Association of Dermatologists 1 or the United States and Canadian Hidradenitis Suppurativa Foundations 1, should be consulted for alternative, evidence-based treatment options.
Future Directions
- Further research is needed to establish the efficacy and safety of upadacitinib specifically in the treatment of hidradenitis suppurativa.
- Until such evidence is available, clinicians must rely on the best available data from related conditions, such as ulcerative colitis, and use their clinical judgment in deciding whether to prescribe upadacitinib off-label for HS.
From the Research
Use of Upadacitinib in Hidradenitis Suppurativa Treatment
- Upadacitinib, a selective Janus kinase inhibitor, has shown promise in the treatment of moderate-to-severe hidradenitis suppurativa (HS) 2, 3, 4, 5.
- A phase 2, randomized, placebo-controlled study found that upadacitinib significantly improved clinical outcomes, with a greater proportion of patients achieving a 50% reduction in total abscess and inflammatory nodule count compared to placebo 2.
- A case report also demonstrated the successful use of upadacitinib as monotherapy for HS and ulcerative colitis in a patient with refractory disease 3.
- A review of the published literature on the use of JAK inhibitors for HS found that upadacitinib has shown promising levels of efficacy and safety, although more studies are needed to fully evaluate its potential 4.
- A systematic review of JAK inhibitors and spleen tyrosine kinase inhibitors for HS treatment found that upadacitinib improved clinical outcomes, with a significant reduction in hidradenitis suppurativa clinical response (HiSCR) and abscess and inflammatory nodule count (AN count) during the treatment period 5.
Safety and Efficacy
- The safety profile of upadacitinib in HS patients has been consistent with previous reports on dermatological conditions, with minimal adverse events reported 2, 5.
- However, a case report of paradoxical HS with Janus kinase inhibitor therapy highlights the potential for adverse events, and further research is needed to fully evaluate the long-term safety and efficacy of upadacitinib in HS treatment 6.
Future Research Directions
- Further studies are needed to fully evaluate the potential of upadacitinib in HS treatment, including larger, longer-term trials to assess its safety and efficacy 2, 4, 5.
- Additional research is also needed to explore the use of upadacitinib in combination with other therapies, and to better understand its mechanisms of action in HS treatment 4, 5.