LAUSR

Background. The pathogenesis of atopic dermatitis (AD) is associated with proinflammatory cytokines and the JAK/STAT signaling pathway. Upadacitinib, an approved oral JAK1 inhibitor, has been investigated in some clinical trials and observational studies of AD. However, the efficacy and safety profile of upadacitinib for AD is still unclear, as few previous meta-analyses evaluated upadacitinib alone. Purpose. To assess the benefit and risk profile of upadacitinib for patients with AD based on evidence from current clinical trials and observational studies. Methods. The study was performed according to PRISMA guidelines. Efficacy outcomes included the proportion of AD patients achieving 50%, 75%, 90%, and 100% improvement in Eczema Area and Severity Index (EASI 50, 75, 90, and 100) and clear or almost clear in Investigator Global Assessment (IGA 0/1) following upadacitinib treatment. Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) was used for quality assessment, and Comprehensive Meta-Analysis (CMA) was used to analyze the extracted data. Results. We enrolled 12 studies from 11 articles, including 6 clinical trials and 6 observational studies. For efficacy, the overall pooled proportions of AD patients achieving EASI 50, EASI 75, EASI 90, and EASI 100 after upadacitinib therapy were 83.3%, 70.5%, 51.8%, and 25.0%, respectively. For safety, the most frequently reported adverse events during upadacitinib treatment were acne (13.2%), and the overall pooled rate of serious adverse events was acceptable (2.2%). The pooled rate of upadacitinib discontinuation was 1.5%, with adverse events (2.2%) and lack of efficacy (1.6%) as the major factors. The subgroup analysis based on dosage regimen revealed that upadacitinib 30 mg/d conferred superior efficacy in treating AD but higher risks of acne than 15 mg/d. Conclusions. Upadacitinib seems to be a promising drug with mild adverse effects in the treatment of AD. More high-quality, large-scale controlled trials are needed for further verification.