Efficacy and safety of upadacitinib in treating immune drift: a single-center, prospective study in China

With the widespread use of biologic agents in dermatology, immune drift has emerged as a growing clinical challenge. Although several case reports suggest the therapeutic potential of JAK inhibitors, clinical evidence for upadacitinib-a highly selective JAK1 inhibitor-remains limited.

A prospective study evaluated the efficacy and safety of upadacitinib in patients with immune drift at the Department of Dermatology, First Affiliated Hospital of Guangxi Medical University, from December 2024 to September 2025.

Eleven patients exhibiting immunological drift (including eight with PSO-AD and three with AD-PSO) were recruited for this investigation, with a mean age of 37.4 ± 18.8 years. Following four weeks of treatment, their IGA 0/1 response rates reached 62.5%. Their EASI scores decreased markedly from 18.0 (12.4-24.4) to 2.5 (0.52-13.1) (p = 0.0059) with EASI-75 and EASI-90 response rates of 63.64% and 45.5%, respectively. Their PASI scores declined significantly from 9.4 (7.4-10.2) to 2.8 (1.85-4.05) (p = 0.001), with PASI-75 and PASI-90 response rates of 45.45% and 18.18%, respectively. Their SCORAD 50 and SCORAD 75 response rates were 72.73% and 36.36%, respectively. The patients' quality of life improved markedly, as evidenced by a reduction in their DLQI scores from 21.8 ± 1.75 to 9.3 ± 8.92 (p = 0.0012) and 54.55% of the patients showing an NRS improvement of ≥4 points. The subgroup analysis revealed an average percentage improvement in EASI score of 72.33% in the PSO-AD cohort and 63.38% in the AD-PSO cohort. No baseline factors were found to be statistically significant predictors of treatment response. In terms of safety, no severe adverse events were documented, and only one patient (9.1%) experienced folliculitis.

Our findings suggest that upadacitinib is effective and safe in managing immune drift, with rapid improvements in disease control and quality of life.