Real-World Evidence of Upadacitinib in Atopic Dermatitis after Inadequate Response or Intolerance to Dupilumab

INTRODUCTIONUpadacitinib and dupilumab are both approved treatments for moderate-to-severe atopic dermatitis (AD). Some dupilumab-treated patients may experience an inadequate response and/or safety/tolerability issues. Real-world data on the effectiveness of upadacitinib in this population remain limited. The objective was to evaluate the effectiveness and safety of upadacitinib in adults diagnosed with moderate-to-severe AD who were inadequate responders to dupilumab or discontinued dupilumab for safety/tolerability reasons.

METHODSCAN UpTIMISE was a Canadian prospective, observational study in adults treated with dupilumab for moderate-to-severe AD with a decision to switch to upadacitinib (15/30 mg), per local label. Effectiveness was assessed over 4 months using the validated Investigator Global Assessment for AD (vIGA-AD), facial IGA, Eczema Area and Severity Index (EASI), Worst Pruritus Numerical Rating Scale (WP-NRS), Dermatology Life Quality Index (DLQI), and Patient Oriented Eczema Measurement (POEM). Results are presented using descriptive statistics.

RESULTSAmong 108 patients (94.4% with vIGA-AD ≥ 2), 83.3% discontinued dupilumab due to inadequate effectiveness and 16.7% discontinued due to safety/tolerability reasons. At month 4, 65.9% (95% CI 55.1-75.2) achieved vIGA-AD 0/1 by observed case analysis (primary outcome), with improvements evident as early as month 1. At month 4 after upadacitinib initiation, 90.2%, 82.9%, and 52.4% of patients achieved EASI ≤ 7, ≤ 3, and ≤ 1, respectively; 70.5% with baseline WP-NRS > 4 had ≥ 4-point reduction and 46.7% reported WP-NRS 0/1. DLQI and POEM scores improved similarly, with 36.0% and 34.3%, respectively, achieving scores indicating no impact or clear/almost clear disease. Minimal disease activity (EASI ≤3 and WP-NRS 0/1) was reached by 43.8% of patients. Upadacitinib was generally well tolerated and no new safety signals were identified.

CONCLUSIONSUpadacitinib provided rapid, clinically meaningful, and generally sustained improvements in disease activity, itch, and quality of life, supporting its role as an effective and well-tolerated treatment for patients with inadequate response or intolerance to dupilumab in real-world practice. Graphical abstract available for this article.

TRIAL REGISTRATIONNCT05394792.

Abstract from PubMed