Real-world Patient Experience of Upadacitinib-Treated Adults with Atopic Dermatitis: Results from the SCALE-UP Study

Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with burdensome symptoms and decreased quality of life.1 Upadacitinib, an oral Janus kinase inhibitor approved to treat moderate-to-severe AD, met all primary endpoints in multiple phase 3 clinical trials for patients with AD.2,3,4 However, clinical trial results may not necessarily reflect outcomes in a real-world setting. There is a need to complement clinical trial findings with real-world data, particularly patient-reported outcomes, which provide a unique perspective of the patient experience. To evaluate the real-world patient-reported experience and effectiveness of upadacitinib in adults with moderate-to-severe AD. The real-world, observational SCALE-UP (Surveying the Clinically Relevant Patient-Reported Outcomes and Long-Term Effectiveness of Upadacitinib in Atopic Dermatitis) study surveyed adults with moderate-to-severe AD participating in a patient support program (PSP) for upadacitinib in the United States. Eligible participants were aged ≥ 18 years, were prescribed and actively receiving upadacitinib for moderate-to-severe AD, and were enrolled in the upadacitinib PSP for 2–12 months. A one-time online survey was used to evaluate patients’ experience with upadacitinib, including the degree of itch improvement and skin clearance, the time to itch improvement and skin clearance, and satisfaction with these items. This cross-sectional analysis included data from 204 patients enrolled in the upadacitinib PSP. The mean (SD) patient age was 45.3 (16.5) years, and the mean (SD) age at AD diagnosis was 30.3 (23.1) years. More than half (70.1%) of patients were female. Upadacitinib treatment duration was 2–6 months for 50.5% of patients and > 6 and ≤ 12 months for 49.5% of patients. The starting upadacitinib dose was 15 mg for 94.6% of patients and 30 mg for 3.9% of patients; at the time of the survey, 79.4% of patients were receiving upadacitinib 15 mg, and 19.6% were receiving upadacitinib 30 mg. Topical corticosteroids were used by 36.8% of patients at the time of the survey. Patients self-reported skin tones (%) were pale white (9.8%), white (39.7%), light brown (23.5%), moderate brown (18.1%), dark brown (5.9%), and deeply pigmented/black (2.5%). After receiving upadacitinib, 94.6% of patients reported itch improvement (86.8% “Very much” or “Much” improved and 7.8% “Minimally” improved. Among patients reporting itch relief, 87.0% noticed itch improvement within 1 week, with 27.5% noticing improvement in ≤ 1 day, 37.8% noticing improvement in 2–3 days, and 21.8% noticing improvement in 4–7 days. Among patients reporting itch relief, the proportions who were “Extremely” or “Very” satisfied with the degree and speed of their itch improvement were 87.0% and 86.0%, respectively. Clearer skin was also reported by 90.7% of patients (81.4% “Very much” or “Much” clearer and 9.3% “Minimally” clearer) after initiating upadacitinib. Of these patients, 89.2% noticed clearer skin within 14 days, with 30.8% noticing clearer skin in ≤ 3 days, 36.8% noticing clearer skin in 4–7 days, and 21.6% noticing clearer skin in 8–14 days. Among patients reporting clearer skin, the proportions who were “Extremely” or "Very” satisfied with the degree and speed of skin clearance were 83.8% and 83.2%, respectively. Patients with moderate-to-severe AD treated with upadacitinib in a real-world setting experienced rapid itch relief and improved skin clearance, and reported high levels of satisfaction with both the degree and time course of itch relief and skin clearance. Results were consistent with the overall efficacy dynamics observed in clinical trials evaluating upadacitinib for treating AD. These real-world data complement clinical trial findings and provide a deeper perspective of patients’ experience when using upadacitinib to manage their moderate-to-severe AD, which may help inform shared decision-making discussions between patients and healthcare providers.