Upadacitinib

Question 1

What is the MOA of upadacitinib?

Answer 1

JAK inhibitor, particularly JAK1

Question 2

How is upadacitinib metabolised?

Answer 2

CYP3A4

Question 3

What are the contraindications to upadacitinib?

Answer 3

Hypersensitivity
Pregnancy/lactation
Severe liver disease

Question 4

What are the Drug interactions of upadacitinib?

Answer 4

CYP3A4 drugs
Other immunosuppr.
Live vaccines

Question 5

What are the adverse effects of upadacitinib?

Answer 5

GI effects
URTI, fever, headache
Dyslipidaemia
Transaminitis
Infections eg herpes zoster
NMSC
Cytopaenias

Question 6

How is upadacitinib dosed?

Answer 6

15mg once daily

Question 7

What baseline and ongoing monitoring is required for upadacitinib?

Answer 7

Baseline
- hx and exam (NMSC & serious infections)
- hepatitis B/C/HIV, quantaferon gold, VzV
- FBC, UEC, LFT, lipid profile, CK

Ongoing
- FBC, UEC, LFT, lipid profile, CK
- FSE

Question 8

What is the PBS criteria for use of upadacitinib in whole body atopic dermatitis?

Answer 8

Initial
Patient 12 years or older
Treated by derm or immunologist
Condition present for at least 6 months
EASI - 20 or more
PGA - 4 or more
DLQI any score
* despite 4 weeks of mod-high potency topical steroids
Sole PBS subsidised biologic for this indication
Must not have failed upadacitinib before

Continuing
Must have received PBS subsidised upadacitinib for this indication
Must have achieved an adequate response in the first 16 weeks
- at least 50% improvement/maintenance in EASI score
- at least 4 point improvement/maintenance in DLQI
Treatment must be sole PBS subsidised biologic for this indication

Question 9

What is the PBS criteria for use of upadacitinib in face / hands dermatitis?

Answer 9

Initial
12 years or older
Dermatologist or clinical immunologist
Disease duration at least 6 months
At least 2 EASI subscores rated severe OR 30% or more surface area of the face or hands, despite 4 weeks of mod-high potency topical steroids
DLQI any score
Sole PBS subsidised biologic
Must not have failed this biologic before

Continuing
Must have received PBS subsidised upadacitinib before for this indication
Must have achieved adequate response in first 16 weeks or maintained adequate response
- rating of 0/1 for at least 3 sub scores OR at least 75% reduction in skin area affected
DLQI improvement of at least 4
Sole PBS subsidised biologic