Effectiveness and safety of upadacitinib on adult dermatomyositis: a cohort study in China

OBJECTIVE: This retrospective study investigated the efficacy and safety of upadacitinib in adult patients with dermatomyositis (DM). METHODS: Adult patients with DM who received upadacitinib between January 2024 and April 2025 were included and followed up for 6 months. Clinical data and complications were collected. RESULTS: The cohort included 40 adult patients with DM, of whom 21 (52.5%) were female. The mean age was 46.93 ± 11.04 years. The median disease duration was 14 (8.25, 31) months. At baseline, the mean disease visual analog scale (VAS) score was 3.93 ± 1.75, and the mean daily glucocorticoid (GC) dose was 29.03 ± 17.02 mg. By the 3-month follow-up, the mean VAS score decreased to 2.57 ± 1.56 (p < 0.001), with significant improvements in cutaneous involvement, interstitial lung disease and manual muscle test 8 score (all p < 0.05). The mean daily GC dose was reduced to 17.66 ± 10.35 mg (p < 0.001). At 6 months, the mean VAS score further decreased to 1.74 ± 1.46 (p < 0.001). The mean daily GC dose was further reduced to 10.65 ± 5.97 mg (p < 0.001). Only four patients with anti-MDA5 antibody showed disease aggravation or relapsed in the cohort. Infection was the most common complication affecting 17 patients, including 6 patients with CMV viraemia and 3 patients with herpes zoster. CONCLUSION: Upadacitinib may be a promising treatment option for adult DM, contributing to clinical improvement and GC dose reduction.