A Systematic Literature Review (SLR) and Network Meta-Analysis (NMA) of Ruxolitinib Cream 1.5% Vs Other Pharmacologic Agents in the Treatment of Atopic Dermatitis (AD)

Speaker(s)

Gooderham M1, Hong HCH2, Wang D3, Hooper B3, Hughes A3, Cameron H3, Wong G4, Marino R5, Dion ML4, Larbi M6
1SKiN Centre for Dermatology, Peterborough, ON, Canada, 2Probity Medical Research and University of British Columbia, Department of Dermatology and Skin Science, Surrey, BC, Canada, 3EVERSANA, Burlington, ON, Canada, 4Incyte Biosciences Canada Corporation, Pointe-Claire, QC, Canada, 5Incyte Corporation, Wilmington, DE, USA, 6Incyte Biosciences Canada Corporation, Pointe Claire, QC, Canada

Presentation Documents

OBJECTIVES: To assess comparative efficacy of ruxolitinib cream 1.5% vs other therapies among patients ≥12 years old with AD.

METHODS: An SLR was conducted to identify randomized controlled trials (RCTs) evaluating ruxolitinib cream 1.5%, oral Janus kinase inhibitors, monoclonal antibodies, phosphodiesterase-4 inhibitors, and immunosuppressants in AD. A feasibility assessment verified an indirect comparison was appropriate and identified suitable methods. NMAs were conducted in a frequentist framework using a penalized likelihood NMA for Investigator’s Global Assessment (IGA) score (0/1), ≥75% improvement in Eczema Area and Severity Index (EASI) from baseline (EASI-75), and ≥4-point improvement in Itch numerical rating scale from baseline (NRS4).

RESULTS: Twenty-three RCTs met inclusion criteria; 12 reported outcomes for patients with IGA=3, EASI ≥16, and affected body surface area ≥10% (“more severe subset of moderate AD”). Due to notable heterogeneity between studies, an NMA with overall trial populations was not feasible. Baseline characteristics were comparable across RCTs for the more severe subset of moderate AD, and an NMA was deemed feasible.

A network of 7 RCTs connected ruxolitinib cream to comparators: dupilumab (300mg), upadacitinib (15mg, 30mg), and placebo for IGA (0/1), EASI-75, and NRS4, as well as abrocitinib (100mg, 200mg) for EASI-75. Outcomes were assessed at Week 8 for ruxolitinib cream 1.5% trials, and Week 12 or 16 in comparator trials.

Ruxolitinib cream 1.5% was superior to placebo for IGA (0/1) and EASI-75. There were no significant differences between ruxolitinib cream 1.5%, dupilumab, upadacitinib, or abrocitinib for IGA (0/1) or EASI-75, although point estimates numerically favored ruxolitinib cream 1.5%. Results for NRS4 were similar across active comparators.

CONCLUSIONS: For patients with moderate AD who may be eligible for systemic therapies, ruxolitinib cream 1.5% may offer similar disease control as systemic treatments. Results may be conservative given the shorter time to response assessment for ruxolitinib cream.

Code

CO112

Topic

Clinical Outcomes

Topic Subcategory

Comparative Effectiveness or Efficacy

Disease

No Additional Disease & Conditions/Specialized Treatment Areas, Sensory System Disorders (Ear, Eye, Dental, Skin)