Oral lichen planus treated with upadacitinib: A case series

Summary: Abstract Body: Oral lichen planus (OLP) is an erosive mucosal subtype of lichen planus characterized by white papules and plaques, reticulated white lines, erythema, and/or ulceration. OLP is often chronic and recalcitrant, and moderate to severe cases frequently require systemic therapies to adequately control the disease. Studies suggest that interferon-γ and its role in activating the JAK-STAT signaling pathway could play a significant part in disease pathogenesis, but little data exists regarding the effect of JAK inhibitors (JAKi) on OLP. We performed a retrospective chart review of patients seen at the University of Utah with biopsy-supported OLP who were treated with upadacitinib. We identified 9 patients, all of whom were female, who had an average age of 67, and 8/9 had erosive disease. Failed medications included hydroxychloroquine, tildrakizumab, and oral immunosuppressants (azathioprine, mycophenolate, cyclosporine). All patients demonstrated insufficient disease control on topical therapy alone. Treatment outcomes were classified as clearance (no erosions, no erythema, no pain), improvement (no erosions, improved erythema, improved reported pain), and no response. The median disease duration before starting upadacitinib was 4 years (IQR: 3-12), and the median number of failed systemic medications prior to upadacitinib was 3 (IQR: 3-7). All patients either improved (n=6, 66.7%) or had disease clearance (n=3, 33.3%), although one patient required increased dosage (30mg/day) to maintain disease control. The average time to complete or partial remission was 1.11 months. These cases suggest that upadacitinib may be a promising option in treating recalcitrant oral lichen planus. More studies need to be done to investigate the use of JAK inhibitors in treating oral lichen planus in larger controlled trials. Annika Hansen², Christiaan Noot¹, Zachary Frost³, Jamie Rhoads¹, Christopher Hull¹, John Zone¹, Zachary Hopkins¹ 1. Dermatology, University of Utah Health, SLC, UT, United States. 2. School of Medicine, University of Utah Health, SLC, UT, United States. 3. Noorda College of Osteopathic Medicine, Provo, UT, United States. Clinical Research: Interventional Research