Upadacitinib Effective in Real-World Setting for Atopic Dermatitis, Regardless of Biologic History

Upadacitinib use among those with atopic dermatitis may lead to clear or almost clear skin for the majority of both bio-naïve and bio-experienced individuals at the 6-month mark, according to recent findings, along with a significant proportion attaining ≥90% Eczema Area and Severity Index (EASI) improvement.1

These late-breaking data, the study of which was titled ‘Real-World Effectiveness of Upadacitinib in Moderate-to-Severe Atopic Dermatitis in Bio-Experienced and Bio-Naïve Patients: Results from 6-Month Longitudinal Analyses of the CorEvitas AD Registry,’ were explored by investigators such as Jonathan Silverberg, MD, PhD, MPH, associate professor of dermatology at The George Washington University School of Medicine.1 The data were released at the 2025 Revolutionizing Atopic Dermatitis (RAD) Conference.

Silverberg and coauthors highlighted that the oral Janus kinase (JAK) inhibitor upadacitinib is approved by the US Food and Drug Administration (FDA) for atopic dermatitis. They also expressed that the exclusion of those with previous exposure to various systemic therapies is common in traditional clinical trials, limiting the generalizability of related findings.

Real-world data can provide a broader perspective on related data by capturing treatment responses in more diverse populations, such as patients previously given biologics. In their analysis, Silverberg et al sought to assess real-world outcomes among both biologic-naïve and biologic-experienced patients given upadacitinib, with data from the CorEvitas Atopic Dermatitis Registry being implemented.

The CorEvitas AD Registry, a prospective, observational study enrolling adults diagnosed with atopic dermatitis, was utilized by the investigative team to enroll participants. The cohort included individuals who had begun treatment with upadacitinib between October 2021 (for Canadians) or January 2022 (for Americans) - April 2024. These subjects would also have completed both a baseline and a 6-month follow-up visit while continuing use of the therapy.

Categorization of those involved as subjects was based on previous utilization of atopic dermatitis-specific biologic drugs. Bio-naïve patients were those without experience, and those with prior use of dupilumab or tralokinumab were considered to be bio-experienced. At the 6-month mark, Silverberg and coauthors’ key clinical endpoints included:

• Attainment of a score of 0 or 1 ("clear" or "almost clear") on the Validated Investigator's Global Assessment for AD (vIGA-AD) among those showing a baseline score of ≥2.
• At least a 90% or 100% improvement attained from the point of baseline in Eczema Area and Severity Index (EASI 90/100) scores.
• Reporting a Peak Pruritus Numeric Rating Scale (PP-NRS) score of 0 or 1 among individuals showing a baseline score >1.
• Reporting a Dermatology Life Quality Index (DLQI) score of 0 or 1 among participants showing a baseline score >1.
• Concurrent achievement of both EASI 90 and PP-NRS 0/1.

There were 108 biologic-naïve and 84 biologic-experienced individuals included in the analysis by the study’s conclusion. The investigative team highlighted that average ages in the bio-naïve cohort had been 45.8 years, with 56.5% being female. Among those in the bio-experienced cohort, the mean age was 47.7 years, and 59.5% were female.

Silverberg et al found that 68.7% of bio-naïve subjects and 62.3% of bio-experienced subjects, among those with moderate or worse atopic dermatitis at baseline (vIGA-AD ≥2), were shown to have attained vIGA-AD scores of 0 or 1.1 Additionally, they found that EASI 90 was met by 64.1% of those in the bio-naïve group and 52.6% of those in the bio-experienced group.

Complete skin clearance (EASI 100) was shown by the investigators as having been reached by 48.5% and 40.8% of these 2 cohorts, respectively. In their evaluation of quality of life, it was noted that 46.0% of those in the bio-naïve arm and 39.7% of the bio-experienced arm had DLQI scores that suggested no or minimal impact of disease (DLQI 0/1) at the point of follow-up.

In their evaluation of itch relief, Silverberg and colleagues highlighted that 52.1% of the bio-naïve group and 34.7% of the bio-experienced group reported a PP-NRS score of 0 or 1. They further noted that, when considering both skin improvement and itch relief together, 54.3% of bio-naïve subjects and 36.2% of bio-experienced subjects had simultaneous EASI 90 and PP-NRS 0/1 responses.

“In routine clinical practice, upadacitinib achieved clear or almost clear skin for the majority of both bio-naïve and bio-experienced patients at 6 months,” the investigative team concluded.1 “A substantial proportion of patients also simultaneously achieved ≥90% EASI improvement and little or no itch. These outcomes align with clinical trial findings, highlighting upadacitinib's real-world effectiveness.”

References

1. Silverberg JI, Gooderham M, Bunick CG, et al. Real-world effectiveness of upadacitinib in moderate‑to‑severe atopic dermatitis (AD) in bio‑experienced and bio-naïve patients: results from longitudinal analyses of the CorEvitas AD registry. Poster presented at: 2025 Revolutionizing Atopic Dermatitis Conference; June 6-7, 2025; Nashville, TN.