Ruxolitinib Cream Has Lower Number Needed to Treat for AD Compared With Other Therapies

Compared with other therapies, ruxolitinib cream had a lower number needed to treat (NNT) for patients with atopic dermatitis (AD), suggesting it may be more effective, according to an analysis of treatments for AD presented in a poster at AMCP 2023.

Researchers analyzed the NNT for prescription topical and systemic medications to treat AD. NNT can be used to demonstrate the value of treatments from a payer perspective because the analysis allows for indirect treatment comparisons across various treatments in a disease.

The NNT was calculated using data from peer-reviewed, published, pivotal phase 3 clinical trials with the primary or co­-primary end point of Investigator’s Global Assessment (IGA) of a 0 or 1, with a 2-point or greater improvement. The following trials were included in the analysis:

• JADE-MONO 1 and JADE-MONO 2 for abrocitinib
• AD-301 and AD-302 for crisaborole
• SOLO 1 and SOLO 2 for dupilumab
• TRuE-AD 1 and TRuE-AD 2 for ruxolitinib cream
• MEASURE UP 1 and MEASURE UP 2 for upadacitinib

Crisaborole has been on the market the longest as it was first approved by the FDA to treat atopic dermatitis in December 2016, followed shortly by dupilumab’s approval in March 2017. Ruxolitinib cream was the first topical Janus kinase (JAK) inhibitor approved to treat atopic dermatitis in September 2021. Approvals for JAK the inhibitors abrocitinib and upadacitinib both came on January 14, 2022.

All of the trials investigated the therapies in patients aged 12 years and older, and NNT was defined as the number of patients who had to be treated for 1 more treatment success on the drug versus either a comparator treatment or placebo. The lower the NNT, the more effective the treatment was.

Comparing ruxolitinib cream and crisaborole, the researchers found the NNT to achieve an IGA of 0/1 with a ≥ 2-point improvement from baseline was lower for ruxolitinib cream:

1. To achieve IGA 0 at week 8, NNT for ruxolitinib cream was 3 vs 7 for crisaborole
2. To achieve IGA 1 at week 8, NNT for ruxolitinib cream was 2 vs 14 for crisaborole

Ruxolitinib cream also had a lower NNT to achieve IGA 0/1 compared with dupilumab among patients with moderate AD. At Week 8 or Week 16 the NNT was 2 for ruxolitinib vs 3 for dupilumab.

For patients with extensive disease who need systemic therapy, ruxolitinib cream was compared with upadacitinib and abrocitinib. The NNT to achieve IGA 0/1 was the same between ruxolitinib cream and upadacitinib (2 vs 2). The NNT to achieve a 75% improvement in baseline in the Eczema Area and Severity Index (EASI-75) was also the same between these treatments, but the NNT to achieve EASI-90 was the same or higher for ruxolitinib cream.

When comparing ruxolitinib cream with abrocitinib, the NNT to achieve IGA 0/1 was lower for ruxolitinib cream (2 vs 3). For EASI score, the NNT to achieve EASI-75 was the same between the 2 therapies, but the NNT to achieve EASI-90 was the same or lower for ruxolitinib cream.

The findings suggest that ruxolitinib cream is more effective than crisaborole for patients with mild to moderate to disease and more effective than dupilumab and abrocitinib for patients with extensive disease who may need systemic therapy. Ruxolitinib cream may have similar efficacy with upadacitinib for patients who may need systemic therapy.

Reference

Lofland JH, Naim A. Examining number-needed-to-treat analyses among various prescription medications for treatment of atopic dermatitis. Presented at: AMCP 2023; March 21-24, 2023; San Antonio, TX.