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Innovative Systemic Treatments for Atopic Dermatitis
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Innovative Systemic Treatments for Atopic Dermatitis

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Dermatology".

Deadline for manuscript submissions: 31 July 2025 | Viewed by 1678

Special Issue Editor

Dr. Luigi Gargiulo

E-Mail Website
Guest Editor
1. Dermatology Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy
2. Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy
Interests: dermatology; psoriasis; atopic dermatitis; JAK-inhibitors
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease that significantly impacts patients’ quality of life and healthcare systems worldwide. Despite its high prevalence and growing therapeutic options, challenges remain in translating advancements in treatment into real-world settings, where diverse patient populations, comorbidities, and variable adherence are critical issues.

Recent breakthroughs in the immunopathogenesis of AD have led to the development of targeted therapies, such as monoclonal antibodies (e.g., dupilumab and lebrikizumab) and JAK inhibitors (e.g., upadacitinib and abrocitinib), showing remarkable efficacy in phase-III clinical trials. However, real-world data on these innovative treatments are essential to bridge the gap between controlled clinical environments and everyday clinical practice. Questions about their long-term effectiveness, safety, impacts on health-related quality of life, and cost-effectiveness in varied healthcare settings remain unanswered.

Real-world studies provide invaluable insights into patient-reported outcomes, treatment patterns, adherence challenges, and the practicalities of managing AD across different healthcare systems. These studies also identify sub-groups of patients who may benefit most from specific therapies and highlight unmet needs in populations under-represented in clinical trials, such as the elderly, those with severe comorbidities, and those with refractory disease.

This Special Issue will highlight the growing importance of real-world evidence in atopic dermatitis care. We welcome original articles and reviews and aim to provide clinicians and researchers with practical guidance for optimizing AD management and improving outcomes in diverse patient populations.

Dr. Luigi Gargiulo
Guest Editor

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Keywords

  • atopic dermatitis
  • atopic eczema
  • JAK inhibitors
  • anti-IL-4
  • anti-IL-13
  • dupilumab
  • tralokinumab
  • lebrikizumab
  • abrocitinib
  • upadacitinib
  • baricitinib

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Published Papers (3 papers)

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Research

11 pages, 1448 KiB  
Article
Super Responders in Moderate-to-Severe Atopic Dermatitis Under Treatment with Dupilumab: An Explorative Real-World Study
by Luca Mastorino, Pedro Mendes-Bastos, Giovanni Cavaliere, Niccolo Siliquini, Michela Ortoncelli, Pietro Quaglino and Simone Ribero
J. Clin. Med. 2025, 14(10), 3480; https://doi.org/10.3390/jcm14103480 - 16 May 2025
Viewed by 104
Abstract
Background: A shared definition of therapeutic targets in the treatment of atopic dermatitis (AD) allows for the identification of patients who respond rapidly (early responders [ERs]) and optimally (super responders [SRs]) to systemic treatments. A concomitant achievement of EASI75/≤7, PP-NRS ≤ 4, SCORAD-75/≤24, [...] Read more.
Background: A shared definition of therapeutic targets in the treatment of atopic dermatitis (AD) allows for the identification of patients who respond rapidly (early responders [ERs]) and optimally (super responders [SRs]) to systemic treatments. A concomitant achievement of EASI75/≤7, PP-NRS ≤ 4, SCORAD-75/≤24, POEM ≤ 7, and DLQI ≤ 5 at 6 months of treatment has been defined as an ideal target for AD. Methods: Patients aged ≥ 12 years treated with dupilumab for moderate-to-severe AD in an Italian center for at least 2 years were analyzed. We defined ERs as those who achieved EASI ≤ 7, PP-NRS ≤ 4, POEM ≤ 7, and DLQI ≤ 5 within 32 weeks, and SRs and long responders (LRs) as those who maintained the target at 1 year and at 2 years, respectively. We subsequently compared baseline characteristics between those who fell within the above definitions and those who did not. Results: Of 171 patients with AD, 76.6% were ERs, 49.1% SRs, and 40.4% LRs. Achievement of combined outcomes was shown by 37.11% of patients at 16 weeks, and increased at the following time points by more than half of patients at 2 years of treatment. Except for a high baseline POEM that appears to be unfavorable for achieving early response (OR 0.93, CI 0.88–0.98, p = 0.006), no baseline characteristics were associated with ERs, SRs, or LRs in this population. Conclusions: According to our definition of responders, we were unable to identify a patient profile at baseline that predicts optimal therapeutic outcomes with dupilumab. Only baseline POEM seems to affect achievement of the selected outcomes. Dupilumab showed a rapid achievement of the outcomes with a stable response after 4 months of treatment, according our definitions. Shared definitions of the different categories of patient responders and a common therapeutic target are necessary for optimal management of AD. Full article
(This article belongs to the Special Issue Innovative Systemic Treatments for Atopic Dermatitis)
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14 pages, 1233 KiB  
Article
Real-World Effectiveness and Safety of Upadacitinib and Abrocitinib in Moderate-to-Severe Atopic Dermatitis: A 52-Week Retrospective Study
by Luciano Ibba, Costanza Falcidia, Sara Di Giulio, Matteo Bianco, Mario Valenti, Paola Facheris, Alessandra Narcisi, Antonio Costanzo and Luigi Gargiulo
J. Clin. Med. 2025, 14(9), 2953; https://doi.org/10.3390/jcm14092953 - 24 Apr 2025
Viewed by 694
Abstract
Background: Atopic dermatitis (AD) is a chronic pruritic inflammatory disease affecting children and adults. Upadacitinib and abrocitinib are selective Janus kinase 1 inhibitors approved for the treatment of moderate-to-severe AD. Although their efficacy and safety are described in phase 3 clinical trials, real-world [...] Read more.
Background: Atopic dermatitis (AD) is a chronic pruritic inflammatory disease affecting children and adults. Upadacitinib and abrocitinib are selective Janus kinase 1 inhibitors approved for the treatment of moderate-to-severe AD. Although their efficacy and safety are described in phase 3 clinical trials, real-world data are limited. Objectives: We aimed to evaluate the effectiveness and safety of upadacitinib and abrocitinib treatment in a real-life adult population with moderate-to-severe AD throughout an extended observation period. Methods: This retrospective observational study was conducted by analyzing data from the electronic records of IRCCS Humanitas Research Hospital from January 2023 to December 2024. Patients were administered either upadacitinib (15 or 30 mg) or abrocitinib (100 or 200 mg). Effectiveness was evaluated by using clinician-reported scores (Investigator Global Assessment [IGA] and Eczema Area and Severity Index [EASI]) and patient-reported outcomes (peak pruritus numerical rating scale [PP-NRS]) at weeks 8, 16, 32 and 52. Statistical significance was set at a probability value (p-value) < 0.05. Adverse events were also collected. Results: In total, 129 patients were included in the study, and 84 of them reached 52 weeks. At week 52, the EASI 75, 90, and 100 responses were 88.9%, 70.8%, and 54.2% for upadacitinib, and 100%, 91.7%, and 75% for abrocitinib. An IGA score equal to 0 or 1 at 52 weeks was achieved by 84.7% of patients treated with upadacitinib and 100% of those receiving abrocitinib. A four-point reduction from baseline PP-NRS was reported by 86.1% for upadacitinib and by 83.3% of patients for abrocitinib after one year of follow-up. Conclusions: Our study showed comparable or even higher effectiveness outcomes in terms of EASI 75, EASI 90, and EASI 100 at week 52 compared to phase-3 clinical trials, with no new safety concerns, supporting the real-world effectiveness of abrocitinib and upadacitinib in moderate-to-severe AD. Full article
(This article belongs to the Special Issue Innovative Systemic Treatments for Atopic Dermatitis)
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12 pages, 799 KiB  
Article
Effectiveness of Tralokinumab Across Atopic Dermatitis Phenotypes
by Francesca Barei, Paolo Calzari, Elena Pezzolo, Maddalena Napolitano, Mariateresa Rossi, Mario Bruno Guanti, Francesca Caroppo, Anna Belloni Fortina, Cataldo Patruno, Anna Campanati, Tommaso Bianchelli, Giovanni Marco D’Agostino, Eustachio Nettis, Francesco Pugliese, Francesca di Vico, Ilaria Trave, Emanuele Cozzani, Luca Stingeni, Katharina Hansel, Matilde Dall’Olio, Laura Grigolato, Rosa Coppola, Vincenzo Panasiti, Martina Maurelli, Giampiero Girolomoni, Michela Ortoncelli, Simone Ribero, Angelo Valerio Marzano and Silvia Mariel Ferrucciadd Show full author list remove Hide full author list
J. Clin. Med. 2025, 14(6), 2077; https://doi.org/10.3390/jcm14062077 - 18 Mar 2025
Viewed by 596
Abstract
Background/Objectives: Tralokinumab, a fully human monoclonal antibody targeting IL-13, has shown efficacy and safety in clinical trials and real-life studies for atopic dermatitis (AD). However, data on its effectiveness across AD phenotypes are limited. Methods: A multicentric study evaluated tralokinumab’s efficacy [...] Read more.
Background/Objectives: Tralokinumab, a fully human monoclonal antibody targeting IL-13, has shown efficacy and safety in clinical trials and real-life studies for atopic dermatitis (AD). However, data on its effectiveness across AD phenotypes are limited. Methods: A multicentric study evaluated tralokinumab’s efficacy over 52 weeks in 416 severe AD patients. EASI (Eczema Area and Severity Index), P-NRS (Pruritus Numerical Rating Scale), DLQI (Dermatology Life Quality Index), and ADCT (Atopic Dermatitis Control Tool) were recorded up to 52 weeks of treatment. Results: The EASI, P-NRS, DLQI, and ADCT trends across phenotypes showed significant improvement in all phenotype subgroups. By week 16, classical and generalized lichenoid phenotypes showed the highest EASI improvements compared to the generalized inflammatory (75.0 vs. 45.5 [p < 0.001] and 79.3 vs. 45.5 [p < 0.001]), with most achieving EASI-75 (p < 0.001, χ2 = 25.96). By week 24, generalized lichenoid reached 100% EASI improvement, significantly outperforming other phenotypes. The highest EASI-75 rates were seen in classical, generalized lichenoid, and portrait/head and neck phenotypes (p = 0.016, χ2 = 13.85). No significant differences were observed at weeks 32, 40, or 52. Conclusions: Our results suggest that tralokinumab’s durability and tolerability are consistent across the various phenotypes. The classical and generalized lichenoid were the fastest phenotypes to improve. However, given the uneven distribution of phenotypes and the gradual reduction in patient numbers over time, larger prospective studies are essential to confirm the observed trends. Full article
(This article belongs to the Special Issue Innovative Systemic Treatments for Atopic Dermatitis)
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