Patients with Atopic Dermatitis Reported Rapid and Optimal Real-World Effectiveness with Upadacitinib: SCALE-UP Study Results by Prior Treatment

Abstract

Introduction Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by itch and eczematous lesions, significantly impairing quality of life (QoL). Safety and efficacy of upadacitinib (UPA), a selective Janus kinase-1 inhibitor approved for the treatment of moderate-to-severe AD, is well established. However, patients with prior advanced systemic therapy (AST) exposure are often underrepresented in clinical trials. Here, we report the effectiveness of UPA by AST exposure in patients with moderate-to-severe AD in the real-world.
Materials and Methods: SCALE-UP is a United States real-world observational, online survey of adults with AD who participated in a patient support program and received UPA for 2-12 months. Patients were stratified into AST-naïve and AST-experienced subgroups based on patient-reported exposure to abrocitinib, dupilumab, or tralokinumab prior to initiating UPA. We report the observed proportion experiencing little-to-no itch (Worst Pruritus Numerical Rating Scale score of 0 or 1 [WP-NRS 0/1]), clear/almost clear skin (body surface area of ≤2 palms [BSA≤2%]), no impact of AD on QoL (Dermatology Life Quality Index score of 0 or 1 [DLQI 0/1]), and no/almost no sleep disturbance (Patient Global Impression of Sleep Disturbance due to AD [PGI Sleep AD 0/1]). Rapidity of itch relief and skin clearance noticed by the patient were also assessed, and safety is not reported in this analysis.
Results Among AST-naïve (N=65; 52.3% >6 months on UPA) and AST-experienced patients (N=159; 49.0% >6 months on UPA), most reported little-to-no itch (AST-naïve: 56.9% | AST-experienced: 54.1%) and clear/almost clear skin (72.3% | 65.4%), with 52.3% and 42.8% achieving both little-to-no itch and clear/almost clear skin, respectively. No impact of AD on QoL was achieved by 50.8% of AST-naïve and 37.7% of AST-experienced patients. Most patients reported no/almost no sleep disturbance (89.2% | 82.4%). Most patients (66.5% | 65.1%) reported noticeable itch improvement within 24 hours. Around one-third of patients (35.6% | 31.3%) reported noticeable skin improvement within 3 days, and most (67.8% | 68.8%) within the first week.
Conclusions AD patients treated with UPA in a real-world setting, including those with prior AST exposure, reported rapid and comprehensive relief across itch, skin, sleep, and QoL outcomes.