Cumulative Disease Control with Upadacitinib in Moderate-to-Severe Atopic Dermatitis-A 52-Week Multicenter Real-World Study: IL-AD (Italian Landscape Atopic Dermatitis)

Introduction: Fixed-timepoint endpoints may not fully capture longitudinal treatment benefit in atopic dermatitis (AD). We evaluated the 52-week real-world effectiveness and safety of upadacitinib, focusing on cumulative disease control. Methods: This multicenter retrospective analysis of prospectively collected LANDSCAPE registry data included patients with moderate-to-severe AD receiving stable upadacitinib 15 mg or 30 mg once daily. Patients who underwent dose modification from 15 to 30 mg or from 30 to 15 mg during the 52-week observation period were excluded from the present analysis to ensure that longitudinal outcomes and cumulative disease-control estimates could be consistently attributed to a stable upadacitinib dose. Outcomes were assessed at baseline and weeks 16, 32, and 52. Moderate disease control was defined as EASI75 plus peak pruritus numerical rating scale (pp-NRS) ≤ 4, and optimal disease control/minimal disease activity (MDA) as EASI90 plus pp-NRS ≤ 1. Cumulative control was estimated as equivalent days in target using a time-in-target approach. Results: Overall, 433 patients were included; 315 (72.7%) received 15 mg and 118 (27.3%) received 30 mg. At week 52, EASI75 and EASI90 were achieved by 85.7% and 72.7% of patients, respectively; moderate and optimal disease control/MDA were achieved by 80.6% and 62.6%. Patients spent a mean of 253.3 ± 101.9 equivalent days in moderate disease control and 176.1 ± 124.4 days in optimal control/MDA. Sustained moderate and optimal disease control from weeks 16 to 52 were achieved by 63.0% and 38.3%, respectively. Overall, 27.0% experienced at least one adverse event, with no permanent treatment discontinuations due to adverse events. Conclusion: Upadacitinib provided sustained real-world disease control over 52 weeks. Time-in-target measures may complement conventional endpoints by better reflecting persistence of therapeutic benefit.