{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T06:15:16Z","timestamp":1783318516741,"version":"3.54.6"},"reference-count":11,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>With the widespread use of biologic agents in dermatology, immune drift has emerged as a growing clinical challenge. Although several case reports suggest the therapeutic potential of JAK inhibitors, clinical evidence for upadacitinib\u2014a highly selective JAK1 inhibitor\u2014remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective study evaluated the efficacy and safety of upadacitinib in patients with immune drift at the Department of Dermatology, First Affiliated Hospital of Guangxi Medical University, from December 2024 to September 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eleven patients exhibiting immunological drift (including eight with PSO-AD and three with AD-PSO) were recruited for this investigation, with a mean age of 37.4 \u00b1 18.8 years. Following four weeks of treatment, their IGA 0\/1 response rates reached 62.5%. Their EASI scores decreased markedly from 18.0 (12.4\u201324.4) to 2.5 (0.52\u201313.1) (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.0059) with EASI-75 and EASI-90 response rates of 63.64% and 45.5%, respectively. Their PASI scores declined significantly from 9.4 (7.4\u201310.2) to 2.8 (1.85\u20134.05) (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.001), with PASI-75 and PASI-90 response rates of 45.45% and 18.18%, respectively. Their SCORAD 50 and SCORAD 75 response rates were 72.73% and 36.36%, respectively. The patients\u2019 quality of life improved markedly, as evidenced by a reduction in their DLQI scores from 21.8 \u00b1 1.75 to 9.3 \u00b1 8.92 (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.0012) and 54.55% of the patients showing an NRS improvement of \u22654 points. The subgroup analysis revealed an average percentage improvement in EASI score of 72.33% in the PSO-AD cohort and 63.38% in the AD-PSO cohort. No baseline factors were found to be statistically significant predictors of treatment response. In terms of safety, no severe adverse events were documented, and only one patient (9.1%) experienced folliculitis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings suggest that upadacitinib is effective and safe in managing immune drift, with rapid improvements in disease control and quality of life.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1842140","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T05:37:51Z","timestamp":1783316271000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and safety of upadacitinib in treating immune drift: a single-center, prospective study in China"],"prefix":"10.3389","volume":"17","author":[{"given":"Wanyan","family":"Xiang","sequence":"first","affiliation":[{"name":"Department of Dermatology, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiarong","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Dermatology, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siqi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Dermatology, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjun","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Dermatology, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiuju","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Dermatology, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1002\/ski2.29","article-title":"Can atopic eczema and psoriasis coexist? A systematic review and meta-analysis","volume":"1","author":"Cunliffe","year":"2021","journal-title":"Skin Health Dis"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2025.1578","article-title":"Psoriasis risk in patients with atopic dermatitis treated with dupilumab","volume":"161","author":"Lin","year":"2025","journal-title":"JAMA Dermatol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1177\/12034754251339122","article-title":"Paradoxical eczema associated with biologic therapy in psoriasis: A systematic review and meta-analysis","volume":"30","author":"Gandhi","year":"2026","journal-title":"J Cutan Med Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"145","DOI":"10.3390\/biomedicines10071485","article-title":"Pathogenesis of paradoxical reactions associated with targeted biologic agents for inflammatory skin diseases","volume":"10","author":"Miyagawa","year":"2022","journal-title":"Biomedicines"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1111\/ijd.17512","article-title":"Upadacitinib for the management of overlapping psoriasis and atopic dermatitis: a case series","volume":"64","author":"Carlos","year":"2025","journal-title":"Int J Dermatol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1104200","article-title":"Mutual antagonism of T cells causing psoriasis and atopic eczema","volume":"365","author":"Eyerich","year":"2011","journal-title":"N Engl J Med"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jid.2022.03.013","article-title":"T helper 2 IL-4\/IL-13 dual blockade with dupilumab is linked to some emergent T helper 17\u2013type diseases, including seronegative arthritis and enthesitis\/enthesopathy, but not to humoral autoimmune diseases","volume":"142","author":"Bridgewood","year":"2022","journal-title":"J Invest Dermatol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1111\/all.15921","article-title":"Development of a clinical algorithm to predict phenotypic switches between atopic dermatitis and psoriasis (the \"Flip-Flop\" phenomenon)","volume":"79","author":"M\u00fcller","year":"2024","journal-title":"Allergy"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(21)00588-2","article-title":"Once-daily upadacitinib versus placebo in adolescents and adults with moderate-to-severe atopic dermatitis (Measure Up 1 and Measure Up 2): results from two replicate double-blind, randomised controlled phase 3 trials","volume":"397","author":"Guttman-Yassky","year":"2021","journal-title":"Lancet"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.19351","article-title":"Successful treatment with tralokinumab in patients with atopic dermatitis and dupilumab-induced psoriasis","volume":"37","author":"Quattrini","year":"2023","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1111\/exd.14958","article-title":"Development of IL-17A inhibitor-induced atopic dermatitis-like rash in psoriasis patients: Insights into immune shift","volume":"33","author":"Li","year":"2024","journal-title":"Exp Dermatol"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1842140\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T05:37:51Z","timestamp":1783316271000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1842140\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,6]]},"references-count":11,"alternative-id":["10.3389\/fimmu.2026.1842140"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1842140","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,6]]},"article-number":"1842140"}}