SCALE-UP: Findings on Real-World Use of Upadacitinib in Atopic Dermatitis

Recent findings on the treatment of patients with atopic dermatitis treated with upadacitinib were presented at the 2025 Fall Clinical Dermatology Conference in Las Vegas, Nevada.1

The data were authored by such investigators as Jonathan Silverberg, MD, PhD, MPH, associate professor of Dermatology at The George Washington University School of Medicine and Health Sciences. The poster was titled ‘Patients With Atopic Dermatitis Reported Rapid and Optimal Real‐World Effectiveness With Upadacitinib: SCALE‐UP Study Results by Prior Treatment.’

In this real-world analysis, drawn from the SCALE-UP study, Silverberg and colleagues looked into the responses of adult patients with moderate-to-severe atopic dermatitis to upadacitinib (UPA) treatment, based specifically on whether these subjects had used advanced systemic therapies (AST) previously.

The highly impactful disease of atopic dermatitis, a chronic inflammatory skin condition marked by persistent pruritus and recurrent eczematous lesions, is uniquely harmful to quality of life among patients. While upadacitinib, a selective Janus kinase (JAK)-1 inhibitor approved for moderate-to-severe disease, has been shown to be efficacious and safe in prior controlled trials, Silverberg et al noted the lack of strong representation of patients with prior systemic biologic or small-molecule treatments.2

Silverberg and coauthors’ investigation was designed to capture treatment efficacy in a real-world environment, specifically comparing outcomes between those with and without prior exposure to such drugs as dupilumab, abrocitinib, or tralokinumab. The team conducted SCALE-UP as an observational, survey-based assessment of adults in the US who had also been involved in a patient support program and had been treated with upadacitinib for at least 2 months and up to 12 months.1

Categorization of study subjects took place, with those involved being placed into either the AST-naïve arm or the AST-experienced arm, based on their self-reported history of treatments. In their survey, the investigative team looked at several different patient-centered endpoints.

Examples of these endpoints included the proportion of participants attaining minimal itch, defined by Silverberg and colleagues as a Worst Pruritus Numerical Rating Scale score of 0 or 1 (WP-NRS 0/1), and the percentage with near-complete skin clearance, indicated by a body surface area disease involvement of 2% or less (BSA ≤ 2%).

Additionally, the team looked at outcomes such as effects on sleep quality based on a Patient Global Impression of Sleep Disturbance due to AD (PGI Sleep AD 0/1) and ratings of quality of life determined by a Dermatology Life Quality Index (DLQI) score of 0 or 1. Those involved in this analysis were also asked how quickly they found improvements in their itch and skin symptoms took place. In this report presented at Fall Clinical, Silverberg et al focused solely on effectiveness and not on safety signals.

There were 65 AST-naïve subjects included in this analysis, with over half of having implemented upadacitinib for more than 6 months. There were 159 AST-experienced patients, with 49.0% having taken upadacitinib for the same length of time. Across both of these cohorts, Silverberg and coauthors identified significant clinical benefits.1

The investigators found reports of minimal itch were noted in 56.9% of AST-naïve individuals and 54.1% of individuals with prior treatment exposure.1 Outcomes among patients related to skin clearance were shown to be similarly strong, with 72.3% of those in the treatment-naïve arm and 65.4% of experienced subjects attaining a BSA of ≤ 2%.

In their conclusions, the team also found more than half of the AST-naïve arm (52.3%) and 42.8% of the experienced arm were able to achieve both little-to-no itch and near-clear skin simultaneously.1 In their evaluation of quality-of-life shifts, the investigators found such improvements to be common, though somewhat more pronounced in treatment-naïve cohort. Specifically, 50.8% of AST-naïve subjects were shown to not have impairments versus 37.7% of AST-experienced subjects.

Respondents to this analysis also reported rapid relief of disease symptoms in approximately two-thirds of each cohort. 66.5% of those labeled AST-naïve and 65.1% of those labeled AST-experienced reported itch reductions within the initial 24-hour period of upadacitinib implementation.1 Sleep-related outcomes were also shown to be positive, with 89.2% of the naïve group and 82.4% of the experienced group describing no or almost no sleep disruption due to their skin condition.

Skin improvement was also identified rapidly, with 35.6% of naïve and 31.3% of experienced subjects perceiving better skin within 3 days.1 Silverberg and colleagues also found 67.8% and 68.8%, respectively, noted such improvement within a single week's time.

Overall, those treated with upadacitinib in this real-world setting, regardless of prior systemic drug use, reported rapid and meaningful benefits across itch, skin manifestations, quality of life, and sleep measures.

For any further information on topics such as these, view the latest coverage of the Fall Clinical Dermatology Conference.

References

1. Silverberg J, Calimlim B, Bunick C. Patients With Atopic Dermatitis Reported Rapid and Optimal Real‐World Effectiveness With Upadacitinib: SCALE‐UP Study Results by Prior Treatment. Poster presented at the 2025 Fall Clinical Dermatology Conference, Las Vegas, Nevada, Oct 23-26, 2025.

2. Guttman-Yassky E, Thaçi D, Silverberg JI, et al. Upadacitinib in adults with moderate to severe atopic dermatitis: 16-week results from a randomized, placebo-controlled trial. J Allergy Clin Immunol. 2020 Mar;145(3):877-884. doi: 10.1016/j.jaci.2019.11.025. Epub 2019 Nov 29. PMID: 31786154.