Real-World Effectiveness and Safety of Upadacitinib Versus Abrocitinib in Moderate-to-Severe Atopic Dermatitis: A...

Background: Janus kinase (JAK) inhibitors have expanded the therapeutic landscape for moderate-to-severe atopic dermatitis (AD), yet real-world comparative data on upadacitinib and abrocitinib remain limited. Objective: We aimed to compare the 24-week real-world effectiveness and safety of upadacitinib 30 mg and abrocitinib 200 mg in adult patients with moderate-to-severe AD, using EASI-75 as the primary efficacy endpoint, and to explore potential clinical factors associated with treatment response. Methods: This retrospective single-center study included adult patients with moderate-to-severe AD treated with upadacitinib 30 mg or abrocitinib 200 mg and followed for 24 weeks in routine clinical practice. A small pediatric subgroup (n = 3) receiving abrocitinib 100 mg was analyzed separately for descriptive purposes only. Clinical outcomes included Eczema Area and Severity Index (EASI), Peak Pruritus Numerical Rating Scale (PP-NRS), EASI-50/75/90 response rates, and NRS-4 response. Safety was assessed using routinely documented adverse events. Exploratory analyses evaluated the possible influence of body mass index (BMI), baseline immunoglobulin E (IgE), and psychological stress on treatment response. Results: Both upadacitinib and abrocitinib were associated with rapid and sustained clinical improvement over 24 weeks. At month 6, EASI-75 response was 83.3% in the upadacitinib group versus 70.8% in the abrocitinib group (p = 0.27). EASI-50 response was significantly higher in the upadacitinib group (100% vs. 83.3%; p = 0.05). Exploratory findings suggested that higher BMI, elevated baseline IgE levels, and psychological stress may be associated with less favorable response trajectories. Both treatments demonstrated a generally favorable safety profile; however, one serious cerebrovascular thrombotic event occurred in a patient with pre-existing cardiovascular risk factors, highlighting the importance of individualized risk assessment when prescribing JAK inhibitors. Conclusions: In routine clinical practice, both upadacitinib and abrocitinib appeared effective for the management of moderate-to-severe AD over 24 weeks. Although upadacitinib 30 mg showed a numerically higher month-6 EASI-50 response, this finding should be interpreted cautiously given the modest sample size and the absence of broader between-group differences across other key efficacy outcomes. Larger prospective studies are needed to confirm comparative effectiveness and to clarify predictors of response and safety in real-world settings.