Clinical Response to Upadacitinib in Treatment-Experienced Patients With Atopic Dermatitis: A Case Series From Latin America

Atopic dermatitis (AD) is a chronic inflammatory skin disease that may require systemic therapy in patients with persistent disease activity or an inadequate response to previous treatments.Upadacitinib, a selective Janus kinase 1 inhibitor, has demonstrated rapid clinical efficacy in patients with moderate-to-severe AD; however, real-world data from Latin American populations remain limited.We describe the clinical responses and treatment outcomes of five adult patients with AD from Mexico who received oral upadacitinib after previous treatment with topical and/or systemic therapies.Clinical response was assessed using the Eczema Area and Severity Index (EASI), Numerical Rating Scale (NRS) for pruritus, and Dermatology Life Quality Index (DLQI) at baseline and week 2, with subsequent follow-up ranging from six months to two years.Four patients initiated upadacitinib 15 mg once daily, whereas one initially received 30 mg once daily and was subsequently reduced to 15 mg because of elevated liver enzyme levels.At week 2, all five patients experienced clinical improvement, with EASI reductions ranging from 40% to 54.5%, NRS reductions of 50-80%, and DLQI scores decreasing to 1-3.All patients maintained clinical improvement during follow-up and ultimately achieved an EASI score ≤3 and a DLQI score of 0. Notably, two patients who had previously experienced disease relapse during dupilumab treatment demonstrated marked improvement after switching to upadacitinib.One patient developed elevated liver enzyme levels approximately 1.5 times the upper limit of normal, which resolved after dose reduction; no other adverse events were reported.These cases highlight the potential role of upadacitinib in treatment-experienced patients with AD, including those with disease relapse following dupilumab treatment.Larger prospective studies are needed to further evaluate its effectiveness and safety in Latin American populations.