Upadacitinib Shows Promise in Treating Systemic Sclerosis-Associated Interstitial Lung Disease

A recent clinical trial has revealed that the JAK inhibitor upadacitinib demonstrates effectiveness in treating systemic sclerosis-associated interstitial lung disease (SSc-ILD). The study, presented at the European Alliance of Associations for Rheumatology (EULAR) 2024 annual Meeting, indicates that upadacitinib reduces the rate of decline in forced vital capacity (FVC) in patients with SSc-ILD, compared to the current standard treatment, mycophenolate mofetil.

Upadacitinib Outperforms Standard Treatment in Lung Function preservation

The research, led by Dr. Manal Hassanien from Assiut University, Egypt, showed that after one year, the difference in the annual rate of decline in FVC between the upadacitinib and mycophenolate groups was 20.9 mL/year, favoring upadacitinib (P = .05).This suggests a meaningful benefit in preserving lung function for patients treated with upadacitinib.

Did You Know? Forced vital capacity (FVC) is the maximum amount of air a person can exhale after a maximum inhalation. It’s a key indicator of lung function.

The double-blinded, randomized study involved 57 patients with SSc, with disease onset of more than 3 years. All participants had an FVC less than 75% of the predicted normal value and evidence of lung fibrosis. Patients were administered either 15 mg of upadacitinib daily or 2000 mg of mycophenolate daily.

Detailed Study Results: FVC and DLCO Improvements

After 52 weeks, a decline of ≥ 5% in FVC from baseline was observed in 20.6% of the upadacitinib group, compared to 37.5% in the mycophenolate group. Furthermore,a 10% drop in FVC from baseline at 1 year was more common in patients taking mycophenolate (17.9%) than in those taking upadacitinib (6.8%).

Changes in diffusing capacity of the lungs for carbon monoxide (DLCO) at 52 weeks were also more favorable in the upadacitinib group (-62.7 mL) compared to the mycophenolate group (-93.3 mL). DLCO measures how well the lungs transfer gas from inhaled air to the bloodstream, providing another critical measure of lung health according to the american Thoracic Society.

Pro tip: Monitoring FVC and DLCO regularly can definitely help track the progression of SSc-ILD and assess the effectiveness of treatments.

Expert Commentary and Future Considerations

Dr. Iulia Szabo, a rheumatologist at “Iuliu Haţieganu” University of Medicine and Pharmacy, Romania, commented on the study, calling the results “really promising.” she noted that previous studies have shown encouraging evidence using other JAK inhibitors in SSc-ILD treatment, although the data were mostly experimental.

Szabo also cautioned that the younger age of participants in the study may mean that older patients could experience a higher risk of adverse events associated with JAK inhibitors.”The problem we might have will be with older patients as we certainly know all the adverse effects that JAK inhibitors have, and probably we should be a bit more cautious,” she said.

Current Treatment Landscape and Upadacitinib’s Potential Role

Currently, upadacitinib is FDA-approved for various conditions, including rheumatoid arthritis, psoriatic arthritis, and Crohn’s disease. However,for SSc-ILD,nintedanib and tocilizumab remain the only FDA-approved treatments. The findings from this study suggest that upadacitinib could potentially become another valuable option for managing this challenging condition.

What are your thoughts on the potential of upadacitinib for treating SSc-ILD?

How might these findings impact treatment strategies for patients with systemic sclerosis?

Disclaimer: This article provides information for general knowledge and awareness only. It does not constitute medical advice and should not be substituted for professional consultation with a qualified healthcare provider.

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