ADMIRE: Upadacitinib Efficacious in Atopic Dermatitis with Prurigo Nodules

Approximately two-thirds of individuals with moderate-to-severe atopic dermatitis and prurigo nodules (AD-PN) attained significant reduction in itch within 12 weeks of initiating upadacitinib in real-world clinical settings, recent data suggest.1

This analysis was authored in Japan and led by such investigators as Hiroyuki Murota, MD, PhD, from the Nagasaki University Graduate School of Biomedical Sciences’ Department of Dermatology. Murota and colleagues’ research was previously released during the 2026 American Academy of Dermatology (AAD) Annual Meeting in Denver, Colorado.

“The efficacy and safety of [targeted immune modulators], including upadacitinib, have been demonstrated in patients with prurigo nodularis, but those in patients with AD-PN are limited,” Murota and coauthors noted.

AD-PN was described by the investigators as one of the most treatment-resistant types of atopic dermatitis, with patients often facing multiple, widespread nodular skin lesions leading to intense levels of pruritus or itch. Upadacitinib, an oral Janus-kinase (JAK)1 inhibitor, is already approved for moderate-to-severe disease, but its use in the specific AD-PN subtype was not well established in real-world clinical settings prior to this analysis.

The ADMIRE study was designed by Murota et al to address that gap in Japan. ADMIRE was a non-interventional, multi-center, prospective observational analysis involving the enrollment of 120 individuals with moderate-to-severe AD-PN. These patients, located across Japan, were recruited between December 2022 - November 2023. They were followed over 48 weeks.

Murota and coauthors’ main endpoint was at least a 4-point reduction in the Worst Pruritus Numerical Rating Scale (WP-NRS) at the 12-week mark. It was determined to be a meaningful threshold suggesting significant relief from pruritus. In terms of secondary endpoints, the investigative team tracked a broad range of clinical and patient-reported outcomes over the entire 48-week period.

The 119 individuals included in the safety analysis were noted to have an average age of about 33, and 57% were labeled as male. At the point of baseline, those assessed showed a high level of disease burden: an average WP-NRS itch scores of 7.2 out of 10, a 46.3% mean level of body surface area involvement, and a significant level of quality-of-life impairment. Approximately 40% had previously implemented systemic agents, including dupilumab, cyclosporine, and other JAK inhibitors.

Overall, Murota and coauthors’ research achieved its primary endpoint, with 65.7% of those evaluated attaining a ≥4-point improvement in WP-NRS at the 12-week mark. Crucially, meaningful improvements were already visible as early as Week 4 across nearly all measures and continued to deepen through Week 48. The number of visible prurigo nodules dipped dramatically, from an average of 26 at the point of baseline to under 3 by the 48-week mark.

Skin clearance also improved substantially, with over 83% of those evaluated showing near-clear or clear nodule staging by Week 48. Additionally, skin pain scores similarly saw improvement, with the investigators highlighting the roughly 60% showing minimal or no pain at the 48-week mark. Quality of life, measured by the DLQI, also saw improvement, with about 39% of participants reporting no disease impact on daily life by Week 48.

Upadacitinib’s safety profile was consistent with what had been noted in prior phase 3 data. Murota et al noted 60% of those assessed experienced at least a single adverse event (AE), most commonly infections (37%), with nasopharyngitis, acne, and influenza being most frequent. Herpes zoster was seen in 5% of subjects. Notably, a lack of major cardiovascular events, venous thromboembolism, tuberculosis, or malignancy was observed.

ADMIRE provides real-world data suggesting upadacitinib may be an efficacious and well-tolerated oral agent among individuals dealing with the challenging AD-PN phenotype, with rapid and durable improvements in pruritus, skin clearance, and quality of life being highlighted primarily.

Notably, Murota et al found no “new safety signals were identified with the observed safety profile similar to that previously reported in phase 3 clinical trials and post-marketing clinical studies for upadacitinib.”1

Editor’s note: These data were summarized with the help of AI tools.

References

1. Murota H, Hagino T, Tada Y, et al. A Prospective Study to Evaluate the Effectiveness of Upadacitinib in Moderate-to-Severe Atopic Dermatitis with Prurigo Nodules in the Real World in Japan: ADMIRE. Presented at the 2026 American Academy of Dermatology (AAD) Annual Meeting, March 27–31, 2026, Denver, CO, USA.