Treatment of AD with Upadacitinib

Targeted Janus kinase (JAK) 1 inhibition suppresses cytokine signaling pathways involved in the pathogenesis of atopic dermatitis. Upadacitinib is FDA approved for both adolescents and adults for the treatment of moderate to severe atopic dermatitis who have failed or have contraindications to alternative systemic treatments. Upadacitinib is available in 15 and 30 mg, once daily doses. Clinical trials have demonstrated superior clinical efficacy compared to placebo and dupilumab in producing short-term clinical response. Important considerations prior to treatment initiation with JAK inhibitors include an increased risk of serious infections, mortality, malignancy, major adverse cardiovascular events (MACEs), and thrombosis. Recommendations for baseline lab monitoring prior to starting upadacitinib include a TB evaluation, viral hepatitis panel, complete blood count (CBC), liver enzymes, and lipid panel. Blood, liver, and lipid level monitoring after treatment initiation may be considered.