Off-Label Use of Upadacitinib for Treatment of Lichen Planus: A Narrative Review

Introduction: Lichen planus (LP) is a chronic inflammatory disorder that primarily affects middle-aged adults and can involve the skin (cutaneous LP), mucous membranes (oral, esophageal, ocular, or vulvar LP), hair (lichen planopilaris, LPP), and nails. The exact cause of LP is not known, but the pathogenesis is thought to be multifactorial and involves T-cell mediated attack of skin and mucous membranes. Objectives: The purpose of this review was to summarize the available reports regarding treatment of LP with the selective and reversible Janus kinase (JAK) 1 inhibitor upadacitinib. Methods: PubMed and Google Scholar databases were queried using LP and upadacitinib terms with Boolean operators and assessed using the Oxford evidence criteria. Results: Sixteen reports were included, comprising a 27 total of patients (19 females and eight males). Most cases were cutaneous LP (N=14, 51.8%) and LPP (N=6, 22.2%). Prior treatments included topical corticosteroids (N=21, 77.8%) and disease-modifying antirheumatic drugs (DMARDs) (N=14, 51.9%). The most common upadacitinib dosages were 15 mg once daily (N=19, 70.4%) and 30 mg once daily (N=5, 18.5%). Most patients achieved remission (N=21, 77.8%) after a median one month which lasted a median three months after treatment cessation or five months in patients who continued to receive treatment. Upadacitinib therapy had minimal, self-limited side effects (N=4, 14.8%). Conclusions: Upadacitinib demonstrates potential as a tolerable and effective off-label treatment for LP. Larger studies are warranted to better define the safety and efficacy of upadacitinib in treating LP.