Upadacitinib in children under 12 years with dupilumab-refractory severe atopic dermatitis: a real-world case series

Therapeutic options for children under 12 years with severe atopic dermatitis (AD) who fail dupilumab remain limited. We retrospectively evaluated nine children with dupilumab-refractory moderate-to-severe AD treated with off-label upadacitinib. At week 24, median EASI decreased from 21 to 2, with 78% achieving EASI-75. Pruritus improved rapidly (median NRS 7 to 1). Treatment was generally well tolerated, with no serious adverse events observed. These findings provide preliminary real-world evidence suggesting that JAK1 inhibition may represent a potential therapeutic option in selected severe pediatric cases. Larger prospective studies are needed to confirm long-term safety and efficacy.