Upadacitinib Effective for Atopic Dermatitis, Maintaining High Retention Rate

Upadacitinib provides patients with atopic dermatitis with a longer-lasting medication option, new real-world findings suggest, with strong overall retention rates among patients with the inflammatory skin disease.1

These results, as well as others, represent the conclusion of a recent analysis that was authored by such investigators as Nadine Abu-Ghazaleh, from the Department of Dermatology at the Royal Melbourne Hospital in Australia. Abu-Ghazaleh and colleagues had highlighted prior to their research that while 1 drug survival study on upadacitinib existed, there had been an overall lack of published Australian data available.2

“Drug survival studies can help dermatologists develop a comprehensive understanding of drug survival rates, factors influencing drug survival, and patient preferences, which can optimise biologic selection and care for [atopic dermatitis] patients,” Abu-Ghazaleh and colleagues wrote.1 “Such data will assist dermatologists in choosing the most suitable biologic, reducing the need for frequent switching, and improving treatment satisfaction, adherence and outcomes.”

The investigative team set out to conduct an analysis of upadacitinib's real-world effectiveness, with the biologic medication having been approved by the Pharmaceutical Benefits Scheme (PBS) for the treatment of atopic dermatitis within Australia. Among their secondary objectives, the team sought to assess any reasons for patients discontinuing the biologic drug, to profile the clinical characteristics of individuals with atopic dermatitis in the Australian setting, and to look into the factors that impact treatment persistence.

The main outcome they evaluated was treatment persistence, defined as the duration from the initiation of upadacitinib use to either cessation, a shift to another biologic option, or patient death—whichever took place first. The investigators recorded trial participants' rationale for discontinuation of the drug and included inadequate initial response, secondary response loss, logistical barriers, any side effects, concurrent infections, and occurrences of subjects being lost to follow-up.

The research team characterized a loss of treatment efficacy by a marked decline in atopic dermatitis control following an initially satisfactory treatment response. This would be typically reported by the participant during the analysis and confirmed by a dermatologist, often signaled by an Eczema Area and Severity Index (EASI) score increase observed in the patient.

The team's analysis drew on data from the BioGrid Database and electronic medical records from the Royal Melbourne Hospital (RMH). Among their criteria for inclusion, the investigators would look at patients who were aged 18 years and older that reported having moderate-to-severe chronic atopic dermatitis and were listed in the BioGrid Database since 2004. Any individuals who had been given at least a single upadacitinib prescription for atopic dermatitis, regardless of whether it was via the PBS or a Compassionate Supply program, were involved in the team's analysis.

The BioGrid Database itself was noted by the investigative team as containing outpatient-level clinical data with significant details, some of which included information on comorbidities, patient demographics, EASI scores, duration of patients' treatments, and intervention types. Medical records among subjects of the study were also used by the team in additional case identification. Classification was based on the ICD-10 diagnostic code L20.9 for atopic dermatitis.

The team looked into a variety of data, including comorbidities, gender, ethnicity, age, existence of related inflammatory conditions such as asthma, history of cigarette-smoking, baseline EASI and Dermatology Life Quality Index (DLQI) scores, and prior lines of treatment.

Overall, their results suggested that upadacitinib had a high medication continuation rate. The investigators specifically noted a drug survival probability of 90.5% at the 4-week mark. Any discontinuations of upadacitinib were attributed to a variety of factors such as infections, adverse events, declining efficacy, and different barriers to ongoing therapy.

There were a set of 14 individuals in the study cohort who had been previously treated with dupilumab and then changed to upadacitinib. The investigative team highlighted the most common reason among these subjects for the switch from dupilumab to upadacitinib as a noted loss of efficacy. This was reported in 50% of these individuals, and 28.6% reported their reason to be a complete lack of efficacy.

“The results of this study have broad implications for clinical practice and healthcare policy," the investigators concluced.1 "By providing real-world evidence on drug survival rates and the factors influencing treatment discontinuation, this research informs clinicians on the relative merits of each biologic in the management of [atopic dermatitis].”

References

1. Abu-Ghazaleh, N., Ross, G. and Morgan, V. (2025), Upadacitinib Drug Survival in the Management of Patients With Moderate to Severe Atopic Dermatitis: Real-Time Data From the Biogrid Database Registry. Australas J Dermatol. https://doi.org/10.1111/ajd.14469.

2. E. Pezzolo, M. Ortoncelli, S. M. Ferrucci, et al., “Drug Survival of Upadacitinib and Predicting Factors of Discontinuation in Adult Patients Affected by Moderate-To-Severe Atopic Dermatitis: An Italian Multicenter Analysis,” Journal of Clinical Medicine 13, no. 2 (2024): 553, https://doi.org/10.3390/jcm13020553.