Network Meta-Analysis Ranks Oral JAK Inhibitors for Short-Term Control of Moderate-to-Severe Atopic Dermatitis
Published in the International Journal of Dermatology, a Bayesian network meta-analysis comparing oral Janus kinase inhibitors (JAKis) for moderate-to-severe atopic dermatitis (AD) found that upadacitinib, particularly at the 30-mg dose, demonstrated the highest short-term efficacy across multiple clinically meaningful endpoints. The findings provide comparative guidance in the absence of head-to-head randomized trials.
The analysis included 9 phase 2 and 3 randomized clinical trials enrolling 4261 adults with moderate-to-severe AD treated with JAK inhibitor monotherapy. The agents evaluated were upadacitinib (15 mg and 30 mg), abrocitinib (100 mg and 200 mg), baricitinib (2 mg and 4 mg), and ivarmacitinib (4 mg and 8 mg). Outcomes were assessed at 12 to 16 weeks and included Eczema Area and Severity Index (EASI)-75, an Investigator’s Global Assessment (IGA) score of 0 or 1, and at least a 4-point reduction in the Itch Numeric Rating Scale score.
Upadacitinib 30 mg ranked highest across all endpoints, achieving the strongest odds for EASI-75 (OR 12.3), IGA-AD 0/1 (OR 18.9), and itch improvement (OR 11.1). Surface under the cumulative ranking curve values consistently placed this dose at the top, with probabilities approaching 98%. Upadacitinib 15 mg ranked second, followed by abrocitinib 200 mg and ivarmacitinib 8 mg. Baricitinib at both studied doses ranked lowest for efficacy.
The authors concluded that “upadacitinib 30 mg, followed by upadacitinib 15 mg, achieved the most consistent short-term efficacy, providing superior skin clearance and itch relief.” They further noted that these findings “support a provisional efficacy preference for upadacitinib in managing moderate-to-severe AD unresponsive to biologic or topical therapies.”
Reference
Babul A, Mehta D, Soliman Y, Hussain M, Babul N. Upadacitinib leads in efficacy: a Bayesian network meta-analysis of four JAK inhibitors in moderate-to-severe atopic dermatitis. Int J Dermatol. Published online January 5, 2026. doi:10.1111/ijd.70228
