Efficacy of abrocitinib and upadacitinib in the treatment of atopic dermatitis and comparison of their efficacy

Atopic dermatitis (AD) is a chronic inflammatory skin disease that typically begins in infancy or early childhood, is driven by pruritus, and follows a relapsing–remitting course. Its pathobiology centers on epidermal barrier dysfunction and a type-2–skewed immune response; together they perpetuate the itch–scratch cycle and chronicity. Clinical expression varies by age and stage, yet itch remains the dominant symptom across all ages, profoundly affecting sleep and quality of life. Treatment aims to restore the barrier and control inflammation; in recent years, targeted agents such as JAK1 inhibitors have been increasingly used in real-world practice. Because AD has psychosocial and systemic consequences beyond the skin, effective and safe long-term strategies are essential. This study aimed to evaluate the real-world effectiveness and safety of upadacitinib and abrocitinib in patients initiated on a JAK1 inhibitor for moderate-to-severe AD at Dicle University Dermatology Clinic between 01.01.2024 and 15.08.2025. In this retrospective observational design, adults received upadacitinib 30 mg or abrocitinib 200 mg; in children, abrocitinib 100 mg was used when clinically indicated. Effectiveness was tracked at baseline and at months 1, 4, and 6 using changes in eczema severity (EASI) and pruritus (NRS-4). Safety was assessed through adverse event/event reporting in visit notes and laboratory monitoring. Exploratory analyses examined associations between treatment response and patient features such as body mass index, total IgE, and history of stress. Over six months, adults treated with upadacitinib 30 mg or abrocitinib 200 mg showed a marked reduction in eczema severity and itch; gains on high-threshold response metrics also occurred but remained more limited within this timeframe. The overall clinical trend in adults favored a more consistent and durable improvement with upadacitinib, while clinically indicated abrocitinib 100 mg in children yielded meaningful improvement by month six. The safety profile was generally manageable; acne and fatigue were most frequent, and upper respiratory tract and herpes infections were observed at times with abrocitinib. A single thrombotic (stroke) event was reported in the upadacitinib arm; it was rare and showed no statistically significant association with treatment group or clinical response. Other evaluations suggested that higher body mass index and elevated total IgE may attenuate response, and a prominent stress history may adversely affect disease course. Taken together, these findings indicate that both JAK1 inhibitors provide clinically meaningful improvement under real-world conditions in the short-to-mid term, with upadacitinib appearing modestly superior in overall adult trajectories. Treatment choice should be individualized by age, comorbidities, infection and thrombosis risk profiles, follow-up practicality, and potential adverse effects; supportive measures—weight management, addressing implications of high IgE, and stress control—may enhance response. Although the retrospective design and limited sample size constrain generalizability, the results support JAK1 inhibitors as effective and manageable options in routine care and underscore the need for longer, prospective, head-to-head studies to consolidate these observations.