Achieving Optimal Skin and Itch Targets Drives Superior Quality-of-Life Outcomes in Atopic Dermatitis
A post hoc analysis of the Measure Up 1 and 2 phase 3 trials demonstrates that achieving optimal skin and itch control in atopic dermatitis (AD) is associated with substantially greater improvements in patient-reported outcomes (PROs) compared with moderate treatment targets. The analysis evaluated outcomes based on treatment targets aligned with AHEAD recommendations, comparing “optimal” (Eczema Area and Severity Index [EASI] 90 + Worst Pruritus Numerical Rating Scale [WP-NRS] 0/1), “moderate” (EASI 75 + ≥4-point improvement in itch), and “neither” groups.
This integrated analysis included 1044 patients randomized to upadacitinib or placebo. Baseline disease burden was high, with a mean EASI score of 29.3 and mean itch score (WP-NRS) of 7.3, indicating severe disease. At week 16, 36.4% achieved optimal targets, 22.1% achieved moderate targets, and 41.5% achieved neither, reflecting the stringent requirement of combined skin and itch control.
Patients achieving optimal targets consistently demonstrated superior PRO outcomes. These patients were substantially more likely to achieve no or minimal impact across domains, including quality of life (Dermatology Life Quality Index/Children’s Dermatology Life Quality Index 0/1), sleep disturbance, skin pain, and anxiety/depression compared with those achieving moderate targets.
Treatment satisfaction was also higher. The proportion of patients who were “very or extremely satisfied” with treatment was greater among those achieving optimal targets (82.0%) compared with moderate responders (68.6%).
“Achieving the optimal skin and itch treatment target (EASI 90 and WP-NRS 0/1) leads to substantially more patients achieving optimal improvements in sleep, pain, anxiety/depression, and quality of life compared with those reaching the moderate target,” the authors concluded. “These results highlight the importance of striving for optimal skin and itch control to maximize patient-reported benefits and alleviate the multidimensional burden of atopic dermatitis.”
These findings reinforce the clinical value of aiming for higher treatment targets in AD, not only for skin clearance but also for broader improvements in patient well-being.
Reference
Kirchhof MG, Bunick CG, Savage LJ, et al. Impact of optimal vs moderate skin and itch treatment targets on patient-reported outcomes in moderate-to-severe atopic dermatitis: insights from Measure Up 1 and 2 phase 3 studies. Presented at: American Academy of Dermatology Annual Meeting; March 27–31, 2026; Denver, Colorado.
