Real-World Effectiveness and Safety of Abrocitinib in Patients with Atopic Dermatitis: A 16-Week Single-Center Retrospective Cohort Study Compared with Upadacitinib and Baricitinib

Abstract

IntroductionAbrocitinib, a selective Janus kinase (JAK)-1 inhibitor, is approved for the treatment of moderate-to-severe atopic dermatitis (AD). Although several real-world studies evaluated the safety and efficacy of abrocitinib, most have been limited by small sample sizes, and there are limited data on South Korean patients with AD. In addition, real-world comparative data across oral JAK inhibitors for AD remain limited.MethodsWe conducted a retrospective, single-center cohort study at the National Medical Center in Seoul, Korea. Patients aged >= 12 years with moderate-to-severe AD (baseline EASI >= 7) who initiated abrocitinib between September 2022 and April 2024 were included in the primary cohort; additional cohorts treated with upadacitinib or baricitinib during predefined periods were analyzed for between-drug comparisons. Efficacy was assessed at baseline, week 2, and week 16 using the Eczema Area and Severity Index (EASI) and patient-reported outcomes (PROs). Safety was evaluated by adverse events (AEs), physical examinations, and laboratory tests.ResultsOf the 66 patients enrolled, 57 patients completed 16 weeks of abrocitinib treatment in the analysis. The mean EASI score significantly decreased after 16 weeks. At week 16, 94.4%, 72.2%, and 25.9% of patients with AD achieved EASI-50, -75, and -90, respectively. Additionally, of the 21 patients who had previously experienced biologics or other JAK inhibitors, 95.5%, 72.7%, and 22.7% achieved EASI-50, -75, and -90, respectively. Further analysis of the EASI breakdown showed improvements of more than 80% across all body regions, with the lower extremities showing the greatest reduction (87.5%) and lichenification exhibiting the highest symptom improvement (89.7%). In descriptive, unadjusted comparisons, abrocitinib showed numerically higher EASI-50 and EASI-75 response rates at week 16 than upadacitinib and baricitinib. Acne was the most frequent adverse event with abrocitinib (43.9%), followed by urticaria (24.6%) and herpes simplex infection (12.3%); no dose reductions or treatment discontinuations due to adverse events occurred.ConclusionAbrocitinib demonstrates real-world efficacy and safety in moderate-to-severe AD, including patients with inadequate responses to other dupilumab or JAK inhibitors, including those with prior exposure to biologics or other JAK inhibitors.