Switching From Dupilumab to Upadacitinib Associated With No Skin Flares in Atopic Dermatitis Analysis
Key Takeaways
A post hoc analysis of the LEVEL UP and HEADS UP trials found no observed skin lesion flares through 16 weeks after patients with moderate-to-severe atopic dermatitis switched from dupilumab to upadacitinib monotherapy following inadequate response.
Itch flares occurred in 3.6% of eligible patients in LEVEL UP and 4.8% in HEADS UP.
The findings were based on observed-case data from two clinical trials and were presented at the 2026 Fall Clinical Dermatology Conference.
Patients with moderate-to-severe atopic dermatitis (AD) who switched from dupilumab to upadacitinib monotherapy following inadequate treatment response experienced no observed skin lesion flares and infrequent itch flares over 16 weeks, according to a post hoc analysis presented at the 2026 Fall Clinical Dermatology Conference in Las Vegas.¹
The presentation, titled “Switching to Upadacitinib Monotherapy Was Associated With Minimal or No Flares Following Inadequate Response to Dupilumab in Patients With Moderate-to-Severe Atopic Dermatitis,” was authored by Drs. Matthew J. Zirwas, Diego Ruiz Dasilva, Mona Shahriari, Ayman Grada, Michael Lane, Brian Calimlim, Meerat Oza, and Christopher G. Bunick.
Skin Lesion and Itch Flares After Treatment Switching
Investigators analyzed patients from the LEVEL UP (NCT05601882) and HEADS UP (NCT03738397) trials who switched to the oral Janus kinase inhibitor upadacitinib after failing to achieve at least 75% improvement in Eczema Area and Severity Index (EASI 75) scores with dupilumab.
The analysis included 207 patients from LEVEL UP and 28 from HEADS UP. Skin lesion flares were defined as an EASI increase of at least 6.6 points, while itch flares were defined as an increase of at least 4 points on the Worst Pruritus Numerical Rating Scale (WP-NRS).
Through 16 weeks after switching, no skin lesion flares occurred among evaluable patients in LEVEL UP (0/201) or HEADS UP (0/27). Among patients with WP-NRS scores of 6 or lower at switching, itch flares occurred in 3.6% (5/139) and 4.8% (1/21), respectively.
“Following an inadequate response to DUPI, switching to UPA monotherapy was associated with no observed skin lesion flares and infrequent itch flares through 16 weeks in LEVEL UP and HEADS UP,” the authors concluded.