Upadacitinib Demonstrates Rapid Improvement in AD Patients With Prurigo Nodules

A new interim analysis from the ADMIRE study, presented at the 2025 Fall Clinical Dermatology Conference, reported that upadacitinib yields rapid and sustained improvements in patients with moderate-to-severe atopic dermatitis (AD) complicated by prurigo nodules, one of the most treatment-refractory AD phenotypes.

"An Interim Analysis of a Prospective Observational Study of Upadacitinib in Patients with Atopic Dermatitis with Prurigo Nodules" was authored by Drs. Hiroyuki Murota, Teppei Hagino, Hidetoshi Takahashi, Shintaro Takeoka, Sei-ichiro Motegi, Motoi Takenaka, Takeshi Ishido, Hiroyuki Hozawa, and Yayoi Tada. The multicenter, prospective observational study conducted enrolled 120 patients with pruriginous AD, characterized by widespread chronic prurigo nodules and persistent itch. Upadacitinib, an oral JAK1 inhibitor, was administered per standard of care, and patients were followed through Week 48.

By Week 12, 67.0% of patients achieved “clear” or “almost clear” status for palpable nodules based on the IGA-CNPG staging system, and 72.5% showed resolution of pruriginous lesions with excoriations or crusts. Notably, 64.3% of patients experienced a ≥4-point reduction in Worst Pruritus Numeric Rating Scale (WP-NRS) at Week 4—the study’s primary endpoint.

Secondary endpoints showed continued improvement through Week 48, with 84.8% of patients achieving EASI 75 and 69.7% reaching EASI 90. Dermatology Life Quality Index (DLQI) scores of 0/1 were observed in 43.5% of patients by Week 48, indicating minimal disease impact on quality of life.

The study also documented a decrease in mean prurigo nodules from 25.8 at baseline to 2.3 by Week 48. Safety findings were consistent with the known profile of upadacitinib. The most common adverse events were acne (20%), influenza (8.3%), and COVID-19 (5.8%), with few serious adverse events reported.

“Our study suggested that upadacitinib ... has a high level of efficacy and safety in patients with moderate-to-severe atopic dermatitis with prurigo nodules,” the authors concluded.