Patients With Atopic Dermatitis Treated With Upadacitinib: Factors Related to Achieving Minimal Disease Activity

Background: Atopic dermatitis (AD) is a chronic skin condition that may require systemic treatments like traditional immunosuppressants or advanced therapies such as upadacitinib, a JAK1-selective inhibitor. Minimal disease activity (MDA), a novel concept combining patient-clinician decision-making, offers a comprehensive measure of disease management, yet its use in real-world drug efficacy studies is limited. Objective: This study aimed to assess the proportion of patients achieving MDA based on pruritus (MDAp) after 16 and 52 weeks of upadacitinib treatment and to explore factors associated with MDA achievement. Methods: A prospective observational study was designed, including patients with moderate-to-severe AD starting treatment with upadacitinib for the first time. MDAp was defined as ≥90% improvement in the Eczema Area Severity Index and Worst Pruritus Numerical Rating Scale score ≤1. Results: Fifty-three patients participated; mean age was 33.53 years (standard deviation 15.40), and 58.5% were women. MDAp was achieved by 62.3% of patients at week 16 and 46.2% at week 52. Patients achieving MDAp at week 16 were older, had shorter disease duration, and had less prior systemic corticosteroid use. Conclusions: Upadacitinib demonstrated efficacy in achieving MDAp in moderate-to-severe AD. Clinical and therapeutic factors identified in this study could help predict treatment success.