Use of upadacitinib in the treatment of moderate to severe atopic dermatitis: patient profiling, dose selection, and therapy modulation, what does real-life teach us?

Purpose: This multicenter retrospective study assessed the real-world effectiveness and safety of upadacitinib in adults with moderate-to-severe atopic dermatitis across eight centers in central Italy.

Materials And Methods: A total of 150 patients received upadacitinib 15 mg or 30 mg daily as monotherapy. Clinical outcomes were evaluated up to 104 weeks using Eczema Area and Severity Index (EASI), itch and sleep numeric rating scale (NRS), and Dermatology Life Quality Index (DLQI).

Severe paradoxical generalized pustular psoriasis induced by adalimumab biosimilar successfully treated with brodalumab.

Paradoxical psoriasis is a rare but increasingly recognized adverse effect of anti-TNF-α therapy, characterized by the onset or exacerbation of psoriatic lesions in patients treated for other immune-mediated conditions. We report the case of a 47-year-old woman with chronic plaque psoriasis who developed severe generalized pustular psoriasis (GPP) after six months of treatment with an adalimumab biosimilar. Given the extent and severity of the eruption and following inadequate response to previous conventional therapies, the patient was treated with brodalumab, an IL-17RA inhibitor.

Evaluation of Upadacitinib Efficacy in the Treatment of Atopic Dermatitis of Sensitive Areas.

Introduction: The treatment of atopic dermatitis (AD) affecting sensitive areas (head and neck, hands, and genitalia) remains a significant challenge, even with the advent of the current range of biologic therapies. Upadacitinib, a selective inhibitor of the JAK1 enzyme, showed promising results in the treatment of AD located in sensitive areas in clinical trials. The aim of this multicenter observational study was to better characterize the effectiveness of upadacitinib in sensitive areas, using specific clinimetric tools.

A long-term real-world safety study of guselkumab in patients with psoriasis who have infectious comorbidities, malignancies or heart disease: the EARLY study.

Background: Guselkumab is proven effective and safe for moderate-to-severe plaque psoriasis, but its safety in patients with comorbid infectious diseases and malignancies has been less studied.

Objectives: The EARLY study was a real-world longitudinal study designed to assess clinical outcomes and long-term safety of guselkumab in patients with psoriasis who also had chronic infections, malignancies or heart disease.

Methods: A cohort of 1024 patients with moderate-to-severe psoriasis treated with guselkumab was evaluated for the presence of chronic infection [hepatitis B virus (HBV) and hepatitis C virus (HCV), tuberculosis and HIV] and cancer.

Predictive Factors for Super Responder Status and Long-Term Effectiveness of Guselkumab in Psoriasis: A Multicenter Retrospective Study.

Introduction: Psoriasis is a chronic inflammatory skin disorder, affecting around 2-3% of the global population. The IL-23/Th17 signaling pathway plays a critical role in disease progression. Guselkumab, an IL-23p19 monoclonal antibody, has shown substantial efficacy in clinical trials for treating moderate-to-severe plaque psoriasis.

Effects of Guselkumab on the FIB-4 Index in Psoriasis Patients (EGIPT): A Three-Year Study.

Psoriasis is associated with comorbidities like metabolic syndrome and nonalcoholic fatty liver disease, increasing the risk of liver fibrosis. This study evaluated the long-term effects of guselkumab on liver fibrosis in 154 psoriasis patients using the Fibrosis-4 (FIB-4) index, a noninvasive marker of fibrosis, over 3 years. Patients were stratified by baseline FIB-4 (≥ 1.

Risk Assessment in Atopic Dermatitis: Guidance from a Multidisciplinary Expert Panel.

Guidelines recommend that patients with severe atopic dematitis (AD) be treated with Janus kinase inhibitors (JAKi). Recently, the safety of JAKi as a class was reviewed by the European Medicines Agency, leading to a modification of the Summaries of Product Characteristics. For upadacitinib, changes involve reduced posology and restriction of its use to patients with no other alternative amongst the elderly and those at an increased risk of major adverse cardiovascular events (MACE), cancer and venous thromboembolism (VTE).

Risankizumab Versus Secukinumab: A Real-World Efficacy and Cost per Responder Comparison in Patients With Psoriasis in Italy.

Introduction: Risankizumab and secukinumab are effective treatment options for patients with moderate to severe psoriasis.

Objectives: We sought to estimate the efficacy and the cost per responder of risankizumab and secukinumab by comparing these two drugs in a real-life setting.

Methods: A multicentric retrospective study was conducted in patients from the Lazio region of Italy affected by moderate-to-severe psoriasis who initiated risankizumab or secukinumab between September 2020 to September 2022.

Efficacy of tildrakizumab 200 mg for treating difficult-to-treat patient populations with moderate-to-severe plaque psoriasis.

Psoriasis is an inflammatory chronic disease of the skin, typically located on the extensor surfaces of the body and the trunk. Patients with psoriasis can often present multiple characteristics, such as lesions located in difficult-to-treat (DTT) areas or high severity of the disease, which can negatively affect their quality of life. There is a lack of consensus in identifying the best therapy for these complex patient populations, especially after the failure of one or multiple lines of therapy.

Rosacea-like eruptions associated with upadacitinib in atopic dermatitis: two case reports and management strategies.

Atopic dermatitis (AD) is a chronic inflammatory skin disease often requiring systemic therapies for moderate-to-severe cases. Janus kinase (JAK) inhibitors, including upadacitinib, have emerged as effective options, targeting pro-inflammatory cytokines involved in AD pathogenesis. However, adverse dermatologic reactions, such as rosacea-like eruptions, have been observed, potentially linked to immune pathway modulation.

A microarray-based IgE-molecular mimicry index (IgE-MMI): A biomarker for disease severity, clinical phenotypes, and therapeutic response in atopic dermatitis?

Background: The role of autoimmune IgE responses in atopic dermatitis (AD) is highly debated. While IgE targeting self-proteins has been extensively studied, IgE responses induced by human-homologous exogenous molecular allergens (HEMAs) remains less understood.

Aim: To investigate whether IgE antibody responses to HEMAs are associated with AD, its severity, and response to dupilumab.

Characterization of Super-Responder Profile in Chronic Plaque Psoriatic Patients under Guselkumab Treatment: A Long-Term Real-Life Experience.

The term "super responder" identifies a group of patients who exhibit a rapid and optimal response to biological treatment compared to the overall treated population. The primary objective of our study is to characterize this subgroup of patients to enable the early identification of those who will respond most effectively to the proposed treatment while also evaluating clinical efficacy. This retrospective study evaluated 232 patients treated with guselkumab in monotherapy for at least 20 weeks between November 2018 and November 2023.

Long-Term Persistence Rate of Secukinumab in Psoriatic Patients: A Six-Year Multicenter, Real-World Experience, Retrospective Study.

: Psoriatic disease, a chronic immune-mediated systemic inflammatory condition, significantly impairs patients' quality of life. The advent of highly targeted biological therapies has transformed treatment strategies, emphasizing the importance of selecting the most effective and cost-efficient option. Secukinumab, an IL-17A inhibitor, has demonstrated efficacy and safety in treating moderate-to-severe plaque psoriasis (PsO).

Impact of Upadacitinib on Atopic Keratoconjunctivitis Exacerbated by Dupilumab Treatment in Atopic Dermatitis Patients: A Prospective Dermatological and Ophthalmological Clinical Evaluation in Common Clinical Practice.

Atopic dermatitis (AD) is a prevalent chronic inflammatory skin condition with a substantial impact on patients, particularly due to ocular involvement known as atopic keratoconjunctivitis (AKC). Current therapeutic approaches, such as dupilumab, often lead to conjunctivitis, prompting exploration of alternative treatments like upadacitinib. We collected dermatological and ophthalmological prospective clinical evaluations of six adults with moderate-to-severe AD, undergoing treatment with upadacitinib after discontinuation of dupilumab due to the onset of AKC during therapy and the worsening of dermatitis in particular in the head and neck region.

Dupilumab-associated ocular surface disease or atopic keratoconjunctivitis not improved by dupilumab? Upadacitinib may clarify the dilemma: A case report.

Dupilumab-associated ocular surface disease is a common clinical sign appearing in patients with atopic dermatitis (AD) just few months after dupilumab treatment start, developing in about 25% of patients. Atopic keratoconjunctivitis (AKC) is a well-identified clinical entity, defined as a chronic inflammatory disease of eye that affects 25%-40% of patients with AD. Most clinical signs of ocular involvement in AD patients treated with dupilumab overlaps the AKC symptoms and signs.

Evaluating the Clinical Meaning of Dermatology Life Quality Index Scores Between Different Phenotypes of Atopic Dermatitis in Patients Before and After Biologic Therapy With Dupilumab.

Atopic Dermatitis (AD) is the most prevalent inflammatory skin disorder resulting in an intense impact on patients quality of life. The aim of this study is to evaluate the clinical meaning of the DLQI scores documented between different phenotypes of AD patients under biologic therapy with Dupilumab. We conducted a retrospective analysis of 209 patients with AD treated with Dupilumab for 2 years.

Efficacy and Safety of Dupilumab in the Treatment of Hand Eczema: A Retrospective Study.

Hand eczema (HE) is a prevalent chronic condition that exerts a substantial and enduring adverse effect on quality of life (QoL) and imposes an economic burden on society. Managing HE poses challenges due to the limited effectiveness and potential adverse effects associated with many currently available topical and systemic treatments. This article examines twenty-one patients affected by HE treated with dupilumab, a fully human monoclonal antibody targeting interleukin IL-4 and IL-13 signaling.

Tildrakizumab: the value of a personalized and flexible approach for treating moderate-to-severe plaque psoriasis in patients with high body weight or high disease burden.

Introduction: The introduction of biologics for the treatment of plaque psoriasis is one of the major therapeutic advances of the last decades in dermatology. The efficacy of this class of drugs can be influenced by multiple factors including obesity, being overweight, prior treatment failures, and disease severity.

Areas Covered: Most of the currently available approved biologics are limited by their lack of dosing flexibility for adapting the therapy to the complexity of real-world patients with psoriasis.

Dupilumab for Treatment of Prurigo Nodularis: Real-Life Effectiveness for up to 84 Weeks.

Prurigo nodularis (PN) is a persistent and inflammatory dermatological condition characterized by chronic itching and the formation of hardened nodules, significantly impacting the affected individuals' quality of life and psychological well-being. The management of PN poses challenges due to the limited efficacy and undesirable side effects associated with current interventions. This article examines sixteen patients affected by PN treated with dupilumab, a fully human monoclonal antibody targeting interleukin IL-4 and IL-13 signaling.

Successful long-term guselkumab treatment of severe plaque psoriasis in patients with class III obesity: A case series.

Data from real-world studies and clinical trials have documented the long-term efficacy and safety of guselkumab in patients with moderate-to-severe psoriasis. Limited data are available on the long-term use of guselkumab in morbidly obese individuals with severe psoriasis. Here, we present data on the outcome of three patients with class III obesity (body mass index (BMI) of ≥40 kg/m) with severe plaque psoriasis treated with 100 mg guselkumab.