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Publications

Journal Article Ahead of print

PubMed: 42728527 DOI: 10.1007/s13555-026-01907-7

Real-World Evidence of Upadacitinib in Atopic Dermatitis after Inadequate Response or Intolerance to Dupilumab: The CAN UpTIMISE Study.

Dermatol Ther (Heidelb)

Authors: Vimal H Prajapati, Vipul Jain, Melinda J Gooderham, Michael Cecchini, Jason K Lee, Charles W Lynde, Parbeer Grewal, Andrew Ferrier, David Préfontaine, Carly Sterling, H Chih-Ho Hong

Affiliations

  • Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
  • Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, AB, Canada.
  • Section of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada.
  • Skin Health & Wellness Centre, Calgary, AB, Canada.
  • Dermatology Research Institute, Suite 310, 8500 Blackfoot Trail S.E. Meadows Mile Professional Building, Calgary, AB, T2G1H7, Canada.
  • Probity Medical Research, Waterloo, ON, Canada.
  • Probity Medical Research, Waterloo, ON, Canada. Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON, Canada. Allergy Research Canada Inc. Niagara Falls, ON, Canada.
  • Probity Medical Research, Waterloo, ON, Canada.
  • SKiN Centre for Dermatology, Peterborough, ON, Canada.
  • Queen's University, Kingston, ON, Canada.
  • York Dermatology Clinic & Research Centre, Richmond Hill, ON, Canada.
  • Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
  • Evidence Based Medical Educator Inc. Toronto, ON, Canada.
  • Toronto Allergy and Asthma Clinic, Toronto, ON, Canada.
  • The Lynde Institute for Dermatology & Lynderm Research Inc. Markham, ON, Canada.
  • Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
  • Rejuvenation Dermatology, Edmonton, AB, Canada.
  • Probity Medical Research, Waterloo, ON, Canada. Stratica Dermatology, Edmonton, AB, Canada. Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
  • AbbVie Inc. North Chicago, Illinois, USA.
  • AbbVie Corporation, Saint-Laurent, QC, Canada.
  • Probity Medical Research, Waterloo, ON, Canada. Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada. Dr. Chih-Ho Hong Medical Inc. Surrey, BC, Canada.

Abstract

INTRODUCTION

Upadacitinib and dupilumab are both approved treatments for moderate-to-severe atopic dermatitis (AD). Some dupilumab-treated patients may experience an inadequate response and/or safety/tolerability issues. Real-world data on the effectiveness of upadacitinib in this population remain limited. The objective was to evaluate the effectiveness and safety of upadacitinib in adults diagnosed with moderate-to-severe AD who were inadequate responders to dupilumab or discontinued dupilumab for safety/tolerability reasons.

METHODS

CAN UpTIMISE was a Canadian prospective, observational study in adults treated with dupilumab for moderate-to-severe AD with a decision to switch to upadacitinib (15/30 mg), per local label. Effectiveness was assessed over 4 months using the validated Investigator Global Assessment for AD (vIGA-AD), facial IGA, Eczema Area and Severity Index (EASI), Worst Pruritus Numerical Rating Scale (WP-NRS), Dermatology Life Quality Index (DLQI), and Patient Oriented Eczema Measurement (POEM). Results are presented using descriptive statistics.

RESULTS

Among 108 patients (94.4% with vIGA-AD ≥ 2), 83.3% discontinued dupilumab due to inadequate effectiveness and 16.7% discontinued due to safety/tolerability reasons. At month 4, 65.9% (95% CI 55.1-75.2) achieved vIGA-AD 0/1 by observed case analysis (primary outcome), with improvements evident as early as month 1. At month 4 after upadacitinib initiation, 90.2%, 82.9%, and 52.4% of patients achieved EASI ≤ 7, ≤ 3, and ≤ 1, respectively; 70.5% with baseline WP-NRS > 4 had ≥ 4-point reduction and 46.7% reported WP-NRS 0/1. DLQI and POEM scores improved similarly, with 36.0% and 34.3%, respectively, achieving scores indicating no impact or clear/almost clear disease. Minimal disease activity (EASI ≤3 and WP-NRS 0/1) was reached by 43.8% of patients. Upadacitinib was generally well tolerated and no new safety signals were identified.

CONCLUSIONS

Upadacitinib provided rapid, clinically meaningful, and generally sustained improvements in disease activity, itch, and quality of life, supporting its role as an effective and well-tolerated treatment for patients with inadequate response or intolerance to dupilumab in real-world practice. Graphical abstract available for this article.

TRIAL REGISTRATION

NCT05394792.

MeSH

Quality Of Life, Safety, Dermatitis, Therapeutics, Dermatitis, Atopic