Hamad Almutlaq
Frequent physician-documented improvement was observed in patients with evaluable follow-up; however, five patients discontinued upadacitinib, including two due to safety, infection, or laboratory concerns. These descriptive findings suggest careful interpretation, patient selection, baseline assessment and frequent clinical and laboratory follow-up.
BACKGROUND: Upadacitinib is an oral Janus kinase 1 inhibitor for moderate-to-severe atopic dermatitis, although real-world evidence from Middle Eastern clinical practice remains limited. The objective of the present study was to describe treatment patterns, physician-documented response, symptom improvement, adverse events, discontinuation, and laboratory monitoring in patients treated with upadacitinib for moderate-to-severe atopic dermatitis.
METHODS: This retrospective descriptive analysis included 30 patients treated with upadacitinib at King Fahd University Hospital between 2023 and 2025. Data were extracted from clinical records and summarized descriptively. Outcomes included dose, treatment duration, response timing, itch and sleep improvement, flare reduction, adverse events, laboratory abnormalities, and discontinuation.
RESULTS: Clinical response was evaluable in 28 patients; two were not evaluable because follow-up documentation was insufficient or unclear. Qualitative physician-documented improvement was recorded in 27 of the 28 evaluable patients, and response was documented within four weeks in 23 of 28. Among patients with paired symptom data, the median pruritus NRS decreased from 8.0 to 2.0, the median sleep-disturbance rating decreased from 8.0 to 2.0, and monthly flare frequency decreased from 5.0 to 1.0. A reduction of at least four points in pruritus NRS occurred in 25 of 28 patients. Retained adverse events occurred in 13 patients. Five patients discontinued treatment, including two because of safety, infection, or laboratory concerns.
CONCLUSION: Frequent physician-documented improvement was observed in patients with evaluable follow-up; however, five patients discontinued upadacitinib, including two due to safety, infection, or laboratory concerns. These descriptive findings suggest careful interpretation, patient selection, baseline assessment and frequent clinical and laboratory follow-up.