Department of Dermatology, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan.
Department of Dermatology, Nippon Medical School, Tokyo, Japan.
J Dermatol. 2023 Dec;50(12):1576-1584. doi: 10.1111/1346-8138.16950. Epub 2023 Sep 4.
Atopic dermatitis (AD) is a chronic eczematous disease with various types of rash, erythema, edema/papulation, excoriation, or lichenification. Janus kinase 1 inhibitor upadacitinib is effective for moderate-to-severe AD. We aimed to investigate the therapeutic effects of upadacitinib on each rash type in AD patients in real-world clinical practice. Seventy-two Japanese patients with moderate-to-severe AD were treated with oral upadacitinib 15 mg/day plus topical corticosteroids. The Eczema Area and Severity Index (EASI) scores for erythema, edema/papulation, excoriation, or lichenification on the whole body or on head and neck, upper limbs, lower limbs, or trunk were assessed at weeks 0, 4, and 12 of treatment. The proportions of patients who achieved resolution or at least 75% reduction of EASI from baseline (EASI 75) for individual rash types were calculated at weeks 4 and 12 on the whole body or each anatomical site. The resolution rates for excoriation, erythema, edema/papulation, or lichenification on the whole body were 38.3%, 23.7%, 21.7%, and 8.3% at week 4 and 18.3%, 18.6%, 11.6%, and 13.3% at week 12, respectively. The EASI scores for all rash types significantly decreased at weeks 4 and 12 compared to week 0. The achievement rates of EASI 75 for excoriation, erythema, edema/papulation, or lichenification on the whole body were 67.2%, 66.7%, 49.2%, and 37.7% at week 4 and 57.3%, 65%, 41%, and 41% at week 12, respectively. The achievement rate of EASI 75 for erythema on head and neck at week 4 (45.3%) was lower than that on upper limbs (71%) and on lower limbs (70.8%), and that on head and neck at week 12 (42.2%) was lower than that on lower limbs (69.2%). These results indicate that upadacitinib is effective for all AD rash types, especially for excoriation and erythema, while head-and-neck erythema might be less responsive to upadacitinib.
特应性皮炎（AD）是一种慢性湿疹性疾病，有多种皮疹类型，如红斑、肿胀/丘疹、糜烂/结痂或苔藓样变。Janus 激酶 1 抑制剂乌帕替尼对中重度 AD 有效。我们旨在研究乌帕替尼在真实临床实践中对 AD 患者各种皮疹类型的治疗效果。72 例中重度 AD 日本患者接受口服乌帕替尼 15mg/天联合外用皮质类固醇治疗。在治疗第 0、4 和 12 周时，评估全身或头颈部、上肢、下肢或躯干的 EASI 评分，以评估红斑、肿胀/丘疹、糜烂/结痂或苔藓样变。在第 4 和 12 周时，计算全身或各解剖部位各皮疹类型从基线（EASI75）改善或至少改善 75%的患者比例。全身糜烂、红斑、肿胀/丘疹或苔藓样变的缓解率分别为第 4 周时的 38.3%、23.7%、21.7%和 8.3%，第 12 周时的 18.3%、18.6%、11.6%和 13.3%。与第 0 周相比，所有皮疹类型的 EASI 评分在第 4 和 12 周时均显著下降。全身糜烂、红斑、肿胀/丘疹或苔藓样变的 EASI75 达标率分别为第 4 周时的 67.2%、66.7%、49.2%和 37.7%，第 12 周时的 57.3%、65%、41%和 41%。第 4 周时头颈部红斑的 EASI75 达标率（45.3%）低于上肢（71%）和下肢（70.8%），第 12 周时头颈部红斑的 EASI75 达标率（42.2%）低于下肢（69.2%）。这些结果表明，乌帕替尼对所有 AD 皮疹类型均有效，特别是对糜烂和红斑，而头颈部红斑可能对乌帕替尼的反应较差。
