Longitudinal Response Trajectories with Dupilumab or Upadacitinib in Moderate-to-Severe Atopic Dermatitis: A Multicentre Real-World Study: IL-AD (Italian Landscape Atopic Dermatitis)

INTRODUCTION: Understanding how treatment responses evolve over time is essential for optimising therapeutic strategies in moderate-to-severe atopic dermatitis (AD). While clinical trials have demonstrated the efficacy of targeted therapies, real-world evidence describing longitudinal response trajectories remains limited. This study aimed to characterise temporal patterns of clinical response in patients with AD treated with dupilumab or upadacitinib in routine clinical practice. METHODS: A multicentre real-world observational study was conducted using data from the Italian AD-Landscape platform, a structured clinical database collecting longitudinal information on patients receiving advanced systemic therapies for AD. Adult patients initiating dupilumab or upadacitinib between July 2019 and January 2026 were included if baseline and at least week-4 assessments were available. Disease severity and patient-reported outcomes were evaluated using the Eczema Area and Severity Index (EASI), Investigator's Global Assessment (IGA), Pruritus Numerical Rating Scale (P-NRS) and Sleep Numerical Rating Scale (S-NRS) at baseline and at weeks 4, 16, 36 and 52. Categorical response thresholds (EASI75, EASI90 and EASI100) and safety outcomes were analysed descriptively. RESULTS: A total of 2625 patients were included (dupilumab n=2085; upadacitinib n=540). Both treatments produced rapid and sustained improvements in clinician-reported and patient-reported outcomes throughout the 52-week follow-up. Mean EASI scores decreased from 25.6 ± 6.5 to 2.2 ± 2.9 in the dupilumab group and from 19.1 ± 9.2 to 2.9 ± 5.7 in the upadacitinib group at week 52, respectively. Upadacitinib demonstrated faster early response kinetics, whereas dupilumab showed a progressive accumulation of clinical benefit over time, resulting in convergence of response rates during long-term follow-up. Safety findings were consistent with known mechanism-specific profiles. CONCLUSIONS: In this large real-world cohort, both dupilumab and upadacitinib provided substantial and sustained clinical improvements in moderate-to-severe AD. Distinct response kinetics were observed, with faster early responses with upadacitinib and progressively increasing responses with dupilumab, supporting a personalised approach to treatment selection in routine clinical practice.

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Journal
Dermatology and Therapy
Published
2026-05-29
DOI
https://doi.org/10.1007/s13555-026-01781-3
Primary Topic
Dermatology and Skin Diseases
Type
article
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article

Longitudinal Response Trajectories with Dupilumab or Upadacitinib in Moderate-to-Severe Atopic Dermatitis: A Multicentre Real-World Study: IL-AD (Italian Landscape Atopic Dermatitis)

Martina Maurelli, Simone Ribero, Agostina Legori, Giovanni Paolino et al.
Dermatology and Therapy
Dermatology and Skin Diseases
article

Longitudinal Response Trajectories with Dupilumab or Upadacitinib in Moderate-to-Severe Atopic Dermatitis: A Multicentre Real-World Study: IL-AD (Italian Landscape Atopic Dermatitis)

Martina Maurelli, Simone Ribero, Agostina Legori, Giovanni Paolino, Maria Esposito, Anna Campanati, Ruggero Cascio Ingurgio, Mario Bruno Guanti, Santo Raffaele Mercuri, Giacomo Dal Bello, Luca Potestio, Elena Pezzolo, Cataldo Patruno, Anna Graziella Burroni, Martina Zussino, Flavia Manzo Margiotta, Federica Veronese, Eustachio Nettis, Silvia Mariel Ferrucci, Alessandra Narcisi, Francesca Barei, Francesca di Vico, Franco RONGIOLETTI, Francesca Satolli, Michela Ortoncelli, Francesca Gaiani, Luigi Gargiulo, Giampiero Girolomoni, Andrea Carugno, Piergiorgio Malagoli, Nicola Zerbinati, Anna Balato, Maddalena Napolitano, Massimo Gola, Matteo Bianco, Paola Savoia, Italian AD-Landscape Group, Mariateresa Rossi, Francesco Loconsole
article en

Abstract

INTRODUCTION: Understanding how treatment responses evolve over time is essential for optimising therapeutic strategies in moderate-to-severe atopic dermatitis (AD). While clinical trials have demonstrated the efficacy of targeted therapies, real-world evidence describing longitudinal response trajectories remains limited. This study aimed to characterise temporal patterns of clinical response in patients with AD treated with dupilumab or upadacitinib in routine clinical practice. METHODS: A multicentre real-world observational study was conducted using data from the Italian AD-Landscape platform, a structured clinical database collecting longitudinal information on patients receiving advanced systemic therapies for AD. Adult patients initiating dupilumab or upadacitinib between July 2019 and January 2026 were included if baseline and at least week-4 assessments were available. Disease severity and patient-reported outcomes were evaluated using the Eczema Area and Severity Index (EASI), Investigator's Global Assessment (IGA), Pruritus Numerical Rating Scale (P-NRS) and Sleep Numerical Rating Scale (S-NRS) at baseline and at weeks 4, 16, 36 and 52. Categorical response thresholds (EASI75, EASI90 and EASI100) and safety outcomes were analysed descriptively. RESULTS: A total of 2625 patients were included (dupilumab n=2085; upadacitinib n=540). Both treatments produced rapid and sustained improvements in clinician-reported and patient-reported outcomes throughout the 52-week follow-up. Mean EASI scores decreased from 25.6 ± 6.5 to 2.2 ± 2.9 in the dupilumab group and from 19.1 ± 9.2 to 2.9 ± 5.7 in the upadacitinib group at week 52, respectively. Upadacitinib demonstrated faster early response kinetics, whereas dupilumab showed a progressive accumulation of clinical benefit over time, resulting in convergence of response rates during long-term follow-up. Safety findings were consistent with known mechanism-specific profiles. CONCLUSIONS: In this large real-world cohort, both dupilumab and upadacitinib provided substantial and sustained clinical improvements in moderate-to-severe AD. Distinct response kinetics were observed, with faster early responses with upadacitinib and progressively increasing responses with dupilumab, supporting a personalised approach to treatment selection in routine clinical practice.

Dermatology and Therapy
University of Pisa (IT), University of Insubria (IT), University of Verona (IT), University of Modena and Reggio Emilia (IT), Marche Polytechnic University (IT), Università degli Studi del Piemonte Orientale “Amedeo Avogadro” (IT), University of Parma (IT), University of Molise (IT), Humanitas University (IT), Vita-Salute San Raffaele University (IT), University of Campania "Luigi Vanvitelli" (IT), University of L'Aquila (IT), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), Azienda Universitaria Ospedaliera Consorziale - Policlinico Bari (IT), IRCCS Policlinico San Donato (IT), Istituto Clinico Sant'Ambrogio (IT), IRCCS Ospedale Galeazzi - Sant'Ambrogio (IT), Federico II University Hospital (IT), Azienda Ospedaliero Universitaria Maggiore della Carita (IT), Azienda Ospedaliera Ospedale Maggiore (IT), Ospedale Policlinico San Martino (IT), Ospedale San Bortolo (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), IRCCS Humanitas Research Hospital (IT), Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele (IT), University of Florence (IT), University of Turin (IT), University of Bari Aldo Moro (IT), University of Naples Federico II (IT), University of Brescia (IT)
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Dermatology and Skin Diseases
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