Long-Term Disease Control During Continuous Treatment with Upadacitinib and Baricitinib for Moderate-to-Severe Atopic Dermatitis: a Real-World Monocentric Retrospective Study

INTRODUCTION: Real-world evidence on long-term effectiveness and safety of oral Janus kinase (JAK) inhibitors in atopic dermatitis (AD) remains limited. This study evaluated sustained long-term clinical and patient-reported disease control and safety during continuous treatment with upadacitinib 30 mg or baricitinib 4 mg. METHODS: This monocentric retrospective study included adults with moderate-to-severe AD treated at IRCCS Humanitas Research Hospital. Eligible patients had baseline assessments and completed longitudinal follow-ups while remaining on their assigned JAK inhibitor. Outcomes were assessed through week 260 for upadacitinib and week 312 for baricitinib and included Eczema Area and Severity Index (EASI) 75/90/100, EASI ≤ 7/≤ 3, Investigator Global Assessment (IGA) 0/1, mean EASI, Peak Pruritus Numerical Rating Scale (PP-NRS), Sleep Disturbance Numerical Rating Scale (SD-NRS) improvement and remission endpoints, and safety. Between-treatment comparisons were considered exploratory only. RESULTS: The long-term cohort included 41 patients: 34 received upadacitinib and 7 baricitinib. At week 260, EASI 75, EASI 90, EASI ≤ 7, and EASI ≤ 3 were achieved by 97.1%, 91.2%, 100.0%, and 91.2% of upadacitinib-treated patients, respectively. In the baricitinib group, EASI 75 was maintained by all patients from week 32 to week 312, and EASI 90, EASI ≤ 7, and EASI ≤ 3 were achieved by all patients at week 312. IGA 0/1 and mean EASI indicated sustained low disease activity during follow-up. At week 260, ΔPP-NRS ≥ 4 and ΔSD-NRS ≥ 4 were maintained in 82.4% and 73.5% of upadacitinib-treated patients and in 85.7% and 71.4% of baricitinib-treated patients, with corresponding baricitinib rates maintained at week 312. Adverse events were infrequent, with no serious adverse events, treatment interruptions, or permanent discontinuations in the long-term cohort. CONCLUSIONS: In selected patients remaining on continuous treatment, upadacitinib and baricitinib were associated with sustained long-term clinical and patient-reported control of moderate-to-severe AD. Larger prospective studies are needed to clarify outcomes after dose reduction or discontinuation and the potential for deeper disease remodeling.