Reasons for Upadacitinib Discontinuation and Risk of Recurrence in the Treatment of Atopic Dermatitis

Treatment discontinuation is common with Janus kinase inhibitors, such as upadacitinib, in moderate-to-severe atopic dermatitis (AD), and this often results in disease relapse and an increased patient burden.

To explore reasons for discontinuation, risk factors, and willingness to reuse upadacitinib.

This retrospective study enrolled 104 patients with AD (50 in the discontinuation, 54 in the non-discontinuation) from Xiangya Third Hospital (Feb-Mar 2026). Data on DLQI, pruritus NRS, and SD-NRS were collected. Recurrence was defined as a ≥25% increase in pruritus after discontinuation. χ² tests, Fisher's exact test, t tests, and logistic regression were used.

Upadacitinib significantly relieved pruritus and improved sleep in both groups. The main reason for discontinuation was satisfactory efficacy, whereas unsatisfactory efficacy was associated with multiple concomitant factors. Shorter diagnosis duration was associated with satisfaction-driven withdrawal, while no such correlation was found among medication continuers. The overall relapse rate was 36.0%. Male sex and smoking were independent relapse risk factors. Among relapsed patients, only 27.8% were willing to resume upadacitinib (61.1% refused). Those who previously discontinued treatment for unfavorable reasons tended to decline retreatment for identical causes.

Upadacitinib is effective for early AD. Close monitoring, targeted education, financial support, and optimized care can improve adherence and reuse willingness.