Upadacitinib 30 mg delivered a placebo-adjusted EASI-90 gain of 54.9 percentage points at Week 16, versus 8.0 points for nemolizumab, in a matching-adjusted indirect comparison (MAIC) of adults and adolescents with moderate to severe atopic dermatitis on background topical corticosteroids.

The AbbVie-funded analysis, presented as Poster P1668 at the 2026 European Academy of Dermatology and Venereology (EADV) Congress in Vienna (September 30–October 3, 2026) and first shown at the Revolutionizing Atopic Dermatitis (RAD) Conference in June 2026, was led by Jonathan I. Silverberg, MD, PhD, MPH, of George Washington University School of Medicine and Health Sciences. No head-to-head randomized trial has compared upadacitinib (Rinvoq), an oral JAK1 inhibitor, with nemolizumab (Nemluvio), an interleukin 31 receptor alpha antagonist.

How did investigators compare the two drugs?

The team anchored individual patient data from the phase 3 AD Up trial (NCT03568318) — upadacitinib 15 mg, 30 mg, or placebo plus topical corticosteroids for 16 weeks — against published aggregate results from the phase 3 ARCADIA 1 and 2 trials of nemolizumab 30 mg, because patient-level nemolizumab data were unavailable.

Researchers reweighted the upadacitinib arm to match nemolizumab trial populations on disease severity scores, age, weight, sex, race, and quality of life. All included trials required:

• EASI score ≥ 16
• Body surface area involvement ≥ 10%
• Worst Pruritus Numerical Rating Scale (WP-NRS) score ≥ 4

Outcomes followed the Aiming High in Eczema/Atopic Dermatitis (AHEAD) framework. Moderate targets were EASI-75, a ≥ 4-point WP-NRS improvement, and both combined; optimal targets were EASI-90 and WP-NRS below 2. Comparisons used placebo-adjusted risk differences with nonresponder imputation.

What did the comparison show?

Before placebo adjustment, matching-adjusted Week 16 EASI-75 rates were 68.3% with upadacitinib 15 mg and 79.2% with 30 mg, against 42.9% reported for nemolizumab in ARCADIA. After placebo adjustment, the gaps widened.

Week 16 placebo-adjusted risk differences:

• EASI-75: 40.8 points (15 mg) and 51.8 points (30 mg) vs 13.4 points for nemolizumab
• EASI-90: 33.7 and 54.9 points vs 8.0 points
• WP-NRS ≥ 4-point improvement: 40.4 and 48.6 points vs 24.0 points
• WP-NRS < 2: 31.4 and 42.2 points vs 18.3 points
• Combined skin–itch target: 36.2 and 48.5 points vs 12.8 points

Risk differences favored both upadacitinib doses across all five outcomes (P < .001). Separation arrived early: significant differences favoring upadacitinib appeared by Week 2 on both itch endpoints and by Week 4 for EASI-75, EASI-90, and the combined target, persisting through every assessment to Week 16.

What limitations should clinicians weigh?

ARCADIA patients could use topical calcineurin inhibitors alongside corticosteroids and completed a topical run-in before baseline — design differences the authors acknowledged could bias comparative estimates. Indirect comparisons cannot account for unmeasured population differences.

The WP-NRS < 2 endpoint was derived post hoc to match ARCADIA reporting, since AD Up originally reported WP-NRS 0/1. AbbVie funded the study, and several authors are company employees.

Until head-to-head data exist, the MAIC gives clinicians a calibrated — if indirect — view of relative efficacy across skin and itch targets, with the magnitude and consistency of the Week 16 differences likely to inform sequencing discussions between oral JAK and IL-31 pathway inhibition in moderate to severe atopic dermatitis.