Effectiveness and Safety of Upadacitinib in Patients with Moderate-to-Severe Atopic Dermatitis and Previous Failures of Th2 Biologics: A Propensity Score-Matched Study.

IF 3.7 4区医学 Q1 DERMATOLOGY

Clinical and Experimental Dermatology Pub Date : 2025-06-11 DOI:10.1093/ced/llaf253

Francesca Barei, Alessandra Chiei-Gallo, Alessandra Narcisi, Ruggero Cascio Ingurgio, Piergiorgio Malagoli, Giampiero Girolomoni, Martina Maurelli, Elena Pezzolo, Claudio Sciarrone, Massimo Gola, Manfredi Magliulo, Paola Savoia, Elia Esposto, Anna G Burroni, Fabrizio Amoruso, Vittoria Giulia Bianchi, Santo R Mercuri, Francesca Satolli, Maria Beatrice De Felici Del Giudice, Paolo Pella, Roberto Pinto, Gianluca Avallone, Carlotta Gurioli, Bianca Maria Piraccini, Anna Balato, Eugenia V Di Brizzi, Rosa Giuseppa Angileri, Flavia Manzo Margiotta, Marco Romanelli, Mariateresa Rossi, Mario Bruno Guanti, Giuseppe Lauretta, Stefano Dastoli, Cataldo Patruno, Maddalena Napolitano, Michela Ortoncelli, Simone Ribero, Angelo V Marzano, Silvia Ferrucci

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引用次数: 0

Abstract

Introduction: Real-world data comparing patients with atopic dermatitis (AD) initially treated with upadacitinib versus those previously treated with biologics or other JAK inhibitors are limited.

Methods: We conducted a retrospective multicenter study of 524 patients with moderate-to-severe AD treated with upadacitinib to assess clinical outcomes over 52 weeks. A sub-analysis of 316 patients compared outcomes between those who had previously failed Th2 biologics (group A) and those who discontinued these treatments for reasons other than inefficacy or were bio-naïve (group B), using a Propensity Score matching method.

Results: A significant clinical improvement starting from week 4 and continuing throughout the study period was observed in the overall population and both in group A and B. Group B showed greater improvements at later follow-up times, with a higher median EASI (Eczema Area and Severity Index) percentage improvement at week 52 (p=0.030), a significantly higher proportion of patients achieving EASI-90 and EASI-100 at week 36 (p=0.023, χ²=9.497). As for the P-NRS (Pruritus Numerical Rating Scale) and SD-NRS (Sleep Distrubances Numerical Rating Scale), group B had a significantly greater percentage of patients reporting a score of 0 or 1 at week 52 (P-NRS: p=0.017, χ²=5.665; SD-NRS: p=0.049, χ²=3.870). Group B also had a significantly higher percentage of patients reaching minimal disease activiy at week 52 (p=0.014, χ²=5.980).

Conclusion: Upadacitinib proved to be effective in the long term not only as a first-line therapy but also in patients with a history of biologic treatment failure. However, patients in Group B consistently demonstrated better clinical responses at later follow-ups, suggesting that bio-naïve individuals and those who discontinued Th2 biologics for reasons other than inefficacy may respond more favorably to upadacitinib.

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Upadacitinib在中重度特应性皮炎和既往Th2生物制剂失败患者中的有效性和安全性：一项倾向评分匹配研究

现实世界中比较最初用upadacitinib治疗的特应性皮炎（AD）患者与先前用生物制剂或其他JAK抑制剂治疗的患者的数据有限。方法：我们对524例接受upadacitinib治疗的中重度AD患者进行了一项回顾性多中心研究，以评估52周的临床结果。使用倾向评分匹配方法，对316例患者进行亚分析，比较先前Th2生物制剂治疗失败的患者（A组）和因无效或bio-naïve以外的原因停止这些治疗的患者（B组）的结果。结果：从第4周开始，在整个研究期间，总体人群以及A组和B组均观察到显著的临床改善。B组在随后的随访时间中表现出更大的改善，在第52周时EASI（湿疹面积和严重程度指数）改善的中位数百分比更高（p=0.030），在第36周达到EASI-90和EASI-100的患者比例显著更高（p=0.023, χ²=9.497）。在瘙痒症数值评定量表（p - nrs）和睡眠障碍数值评定量表（SD-NRS）中，B组患者在第52周报告得分为0或1分的比例显著高于B组(p - nrs: p=0.017, χ²=5.665；SD-NRS: p=0.049, χ²=3.870)。B组患者在第52周达到最低疾病活动度的比例也显著高于B组（p=0.014, χ²=5.980）。结论：Upadacitinib不仅作为一线治疗，而且对有生物治疗失败史的患者长期有效。然而，B组患者在随后的随访中始终表现出更好的临床反应，这表明bio-naïve个体和因非无效原因停用Th2生物制剂的患者可能对upadacitinib的反应更有利。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical and Experimental Dermatology 医学-皮肤病学

CiteScore

3.20

自引率

2.40%

发文量

389

审稿时长

3-8 weeks

期刊介绍： Clinical and Experimental Dermatology (CED) is a unique provider of relevant and educational material for practising clinicians and dermatological researchers. We support continuing professional development (CPD) of dermatology specialists to advance the understanding, management and treatment of skin disease in order to improve patient outcomes.