Atopic Dermatitis and Ulcerative Colitis Successfully Treated with Upadacitinib

Abstract

Background and Objectives: JAK inhibitors entered current clinical practice as treatment for several immune-related diseases and, recently, for atopic dermatitis. These drugs target the Janus Kinase intracellular cascade, rendering them suitable for treating both Th1 and Th2 immune-mediated responses. Materials and Methods: We report the case of a 36-year-old male patient presenting an overlap of ulcerative colitis, a Th1-related disease, and atopic dermatitis, a Th2-mediated condition. Treatment with upadacitinib was initiated, and laboratory and instrumental follow-ups were carried out for 8 months. Results: The complete and persistent clinical remission of both conditions was observed at a low dose of 15 mg of upadacitinib, even though ulcerative colitis guidelines usually recommend a dosage of 45 mg. No serious adverse responses to therapy were reported. Conclusions: Upadacitinib may be the most suitable management strategy in subjects with coexisting severe conditions mediated by Th1 inflammation, such as ulcerative colitis, and by Th2 cytokines, such as atopic dermatitis.

Gastrointestinal Comorbidities Associated with Atopic Dermatitis—A Narrative Review

“…A case report highlights that the administration of upadacitinib at a dosage of 15 mg was an appropriate therapeutic choice for a 36-year-old male patient with both UC, a Th1-related disease, and AD, a Th2-mediated condition [85]. Both diseases were found to have a total and long-term clinical remission [85]. It is also noteworthy that the patient was initially classified as a low responder to dupilumab treatment [85].…”

“…We attempted to establish connections between the pathogenesis of the diseases and immunology, as this may be the determining factor in identifying common pathways and applying medicines that are effective in treating not one but two diseases. A case report highlights that the administration of upadacitinib at a dosage of 15 mg was an appropriate therapeutic choice for a 36-year-old male patient with both UC, a Th1-related disease, and AD, a Th2-mediated condition [85]. Both diseases were found to have a total and long-term clinical remission [85].…”

“…Both diseases were found to have a total and long-term clinical remission [85]. It is also noteworthy that the patient was initially classified as a low responder to dupilumab treatment [85]. We additionally looked for some other links, such as genetics, that may, in the future, to some extent, predict the disease onset.…”

Biologics and small molecules treatment for moderate-to-severe atopic dermatitis patients with comorbid conditions and special populations: an Italian perspective

“…Grieco et al . reported a case of a patient with overlapping AD and UC who was successfully treated for both conditions with UPA 15 mg. 77 UPA may hold promise as a treatment option for patients with concurrent AD and IBD.…”

“…Clinical trials have demonstrated the efficacy and tolerability of UPA in IBD patients, leading to its approval by AIFA for the induction and maintenance therapy of moderate-to-severe UC and CD (73)(74)(75)(76)(77)(78)(79)(80)(81)(82).…”