Early itch relief with upadacitinib predicts later skin clearance in Atopic dermatitis

J Dermatolog Treat. 2024 Dec;35(1):2291317. doi: 10.1080/09546634.2023.2291317. Epub 2023 Dec 11.

Abstract

Background: Though Janus kinase inhibitors such as upadacitinib rapidly relieve itch in atopic dermatitis (AD) patients, how early itch relief impacts later skin clearance is not examined.

Objectives: This study aims to determine if early itch relief by upadacitinib could predict complete skin clearance in later phases.

Methods: This retrospective study involved 105 patients with moderate-to-severe AD treated with upadacitinib 15 mg/day. Eczema area and severity index (EASI), atopic dermatitis control tool, and achievement rate of EASI 100 were evaluated at weeks 4, 12, and 24. The threshold of early peak pruritus-numerical rating scale (PP-NRS) predicting later skin clearance was assessed by area under the receiver-operating characteristic curve, and predictors for EASI 100 achievement were determined by logistic regression analysis.

Results: The rate of achieving EASI 100 at week 24 was extremely higher in patients who achieved week 2 PP-NRS ≤ 1 (42.9%) than in non-achievers (1.4%). The logistic regression analysis showed that the achievement of week 2 PP-NRS ≤ 1 and low body mass index were associated with achievement of EASI 100 at weeks 12 and 24.

Conclusions: The achievement of week 2 PP-NRS ≤ 1 may predict later skin clearance in upadacitinib treatment.

Keywords: Atopic dermatitis; Janus kinase inhibitor; itch; skin clearance; upadacitinib.

MeSH terms

  • Dermatitis, Atopic* / complications
  • Dermatitis, Atopic* / drug therapy
  • Diphenhydramine
  • Double-Blind Method
  • Heterocyclic Compounds, 3-Ring
  • Humans
  • Pruritus / drug therapy
  • Pruritus / etiology
  • Retrospective Studies
  • Severity of Illness Index
  • Skin
  • Treatment Outcome

Substances

  • upadacitinib
  • Heterocyclic Compounds, 3-Ring
  • Diphenhydramine