Real-world effectiveness and safety of upadacitinib for the treatment of atopic dermatitis in adult patients switched from dupilumab: A multicenter retrospective study

To the Editor: Dupilumab, a monoclonal antibody targeting the interleukin-4 receptor alpha (IL-4Ra), was the first advanced systemic therapy approved for the treatment of moderate-to-severe atopic dermatitis (AD). However, many patients do not respond to the treatment, experience disease relapse, or develop an adverse event (AE). 1 Gori N. Ippoliti E. Antonelli F. Peris K. Chiricozzi A. Successful response to upadacitinib in the treatment of atopic dermatitis lesions involving sensitive and visible areas resistant to dupilumab treatment. Clin Exp Dermatol. 2023; 48: 558-559https://doi.org/10.1093/ced/llad040 Crossref PubMed Scopus (4) Google Scholar Upadacitinib, a selective Janus kinase (JAK) inhibitor, has demonstrated superior efficacy compared with dupilumab when evaluating skin clearance and itch improvement in a head-to-head clinical trial and network meta-analysis. 2 Blauvelt A. Teixeira H.D. Simpson E.L. et al. Efficacy and safety of Upadacitinib vs Dupilumab in adults with moderate-to-severe atopic dermatitis: a randomized clinical trial. JAMA Dermatol. 2021; 157: 1047-1055https://doi.org/10.1001/jamadermatol.2021.3023 Crossref PubMed Scopus (195) Google Scholar ,3 Silverberg J.I. Hong H.C.-H. Thyssen J.P. et al. Comparative efficacy of targeted systemic therapies for moderate to severe atopic dermatitis without topical corticosteroids: systematic review and network meta-analysis. Dermatol Ther (Heidelb). 2022; 12: 1181-1196https://doi.org/10.1007/s13555-022-00721-1 Crossref PubMed Scopus (20) Google Scholar However, real-world evidence is limited when evaluating outcomes with upadacitinib in patients with AD who have recently switched from dupilumab. Our aim was to assess the effectiveness and safety of upadacitinib in this specific population.