Efficacy and safety of upadacitinib for the treatment of moderate-to-severe atopic dermatitis: a systematic review and meta-analysis

Introduction: Upadacitinib, an oral selective-JAK1 inhibitor, has been used in clinical trials to treat atopic dermatitis (AD). Aim: To evaluate the efficacy and safety of upadacitinib in moderate-to-severe AD. Material and methods: We searched clinical trials from PubMed, Embase, Cochrane Library databases, and Web of Science. All randomized controlled trials (RCTs) of upadacitinib treatment on patients with moderate-to-severe AD were included. A meta-analysis was performed using the fixed-or random-effects models to calculate pooled standard mean differences or relative risks (SMD or RR, respectively).Results: Compared with the placebo group, our meta-analysis revealed that upadacitinib was related to a significant decrease in Eczema Area and Severity Index (EASI) scores, and pruritus numeric rating scale (NRS) scores. A higher response rate in Investigator's Global Assessment (IGA) and EASI-75 were also detected in the upadacitinib group. Although patients treated with upadacitinib experienced a higher incidence of adverse events (AEs), these AEs were mild and tolerated. As for serious adverse events (SAEs), there was no difference between the placebo group and the upadacitinib group.Conclusions: This meta-analysis demonstrated that upadacitinib is a safe and effective treatment for moderate-to severe AD. Further long-term trials are required for confirmation.