Upadacitinib Delivers Rapid, Sustained Improvements in Severe Atopic Dermatitis in Real-World Cohort
A real-world retrospective cohort study suggests that upadacitinib provides meaningful and sustained clinical improvement in patients with severe atopic dermatitis (AD), including those with prior systemic and biologic treatment exposure and involvement of difficult anatomical sites.
“Severe AD involving special sites, such as the face, scalp, hands, feet or genital area, is associated with increased disease burden and therapeutic challenges,” the investigators noted. They aimed to evaluate the effectiveness and safety of upadacitinib in a real-world cohort of patients with severe, treatment-experienced AD.
This retrospective observational study was conducted at a tertiary dermatology center in Spain (2021–2025) and included 24 adults with severe AD. Nearly all patients (95.8%) had received prior systemic therapy, including biologics such as dupilumab (75.0%). Outcomes included Eczema Area and Severity Index (EASI), body surface area, SCORing Atopic Dermatitis, Physician Global Assessment, and pruritus scores, assessed at baseline, 3 months, 6 months, and 18 months.
Clinical improvement was both rapid and sustained. A substantial proportion of patients achieved EASI75, EASI90, and minimal disease activity over time, with continued improvement through 18 months. Patients with special site involvement demonstrated particularly strong responses, suggesting effectiveness even in traditionally difficult-to-treat areas.
Safety outcomes were favorable. Adverse events occurred in 29.2% of patients, most commonly acne (16.7%), along with isolated cases of herpes zoster, weight gain, and hypercholesterolemia. All reported adverse events were mild, and no serious safety signals were identified.
“In this real-world cohort of patients with severe and previously treated AD, upadacitinib demonstrated rapid and sustained clinical improvement,” the authors reported. “These findings further support the role of upadacitinib as an effective treatment option in difficult-to-treat atopic dermatitis.”
These real-world findings reinforce the potential of upadacitinib as a treatment option for patients with severe, refractory AD, including those with involvement of high-burden anatomical sites.
Reference
Román Cheuque RP, Aguilar González L, Durán Romero AJ, et al. Real-world outcomes of upadacitinib in severe atopic dermatitis: a retrospective cohort study. Presented at: American Academy of Dermatology Annual Meeting; March 27–31, 2026; Denver, Colorado.
