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Background: Alopecia areata (AA) is a hair loss disorder that can seriously impact quality of life. Janus kinase (JAK) inhibitors, including deuruxolitinib, have previously demonstrated significant hair regrowth in AA., Objective: The Phase 3 THRIVE-AA1 randomized, double-blinded, placebo-controlled trial (NCT04518995) evaluated the safety and efficacy of the oral JAK1/JAK2 inhibitor deuruxolitinib in adult patients with AA., Methods: Patients aged 18-65 years with ≥50% hair loss were randomized to deuruxolitinib 8 mg twice daily, deuruxolitinib 12 mg twice daily, or placebo for 24 weeks. The primary end point was the percentage of patients achieving a Severity of Alopecia Tool score ≤20. A key secondary end point was the percentage of satisfaction of hair patient-reported outcome responders., Results: Significantly higher proportions of patients taking deuruxolitinib met the primary end point (8 mg 29.6%; 12 mg 41.5% versus placebo 0.8%). Both deuruxolitinib doses achieved significant improvements in all secondary end points versus placebo, including satisfaction of hair patient-reported outcome (8 mg 42.1%; 12 mg 53.0% versus placebo 4.7%). Most treatment-emergent adverse events were mild or moderate, consistent with other oral JAK inhibitors., Limitations: Further studies are required to understand longer-term safety, efficacy, and impact of treatment cessation., Conclusion: Both doses of deuruxolitinib were effective for hair regrowth. Patient satisfaction aligned with hair growth., Competing Interests: Conflicts of interest Dr King has served on advisory boards and/or is a consultant and/or is a clinical trial investigator for AbbVie, AltruBio Inc, Almirall, AnaptysBio, Arena Pharmaceuticals, Bioniz Therapeutics, Bristol Myers Squibb, CoNCERT Pharmaceuticals (subsequently acquired by Sun Pharmaceutical Industries Limited), Equillium, Horizon Therapeutics, Eli Lilly, Incyte Corp., Janssen Pharmaceuticals, LEO Pharma, Otsuka/Visterra Inc, Pfizer, Regeneron, Sanofi Genzyme, Sun Pharmaceutical Industries Limited, TWi Biotechnology Inc, and Viela Bio Inc; also served on speaker bureaus for AbbVie, Incyte, Eli Lilly, Pfizer, Regeneron, and Sanofi Genzyme and is a scientific advisor for BiologicsMD. Dr Senna has been a speaker for Eli Lilly and Pfizer and a principal investigator and/or received research funding from Follica, Eli Lilly, CoNCERT Pharmaceuticals (subsequently acquired by Sun Pharmaceutical Industries Limited), Santiste Medical, and LEO Pharma; has also served on scientific advisory boards and/or been a consultant for Eli Lilly, Follica, L'Oreal, Kintor, and Pfizer, and is on the board of directors/medical advisory board for the National Alopecia Areata Foundation, Scarring Alopecia Foundation, and the American Hair Research Society. Dr Mesinkovska has been an advisor for CoNCERT Pharmaceuticals (subsequently acquired by Sun Pharmaceutical Industries Limited), Eli Lilly, and Pfizer, a principal investigator for AbbVie, Arcutis Biotherapeutics, Bristol Myers Squibb, CoNCERT Pharmaceuticals (subsequently acquired by Sun Pharmaceutical Industries Limited), Eli Lilly, and Pfizer and a speaker for Eli Lilly. Dr Lynde has been a speaker and/or consultant for AbbVie, Amgen, Aralez, Arcutis, Bausch Health, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Cipher, Dermavant, Devonian, Eli Lilly, Fresenius Kabi, Galderma, GSK, Incyte, Innovaderm, Intega Skin, Janssen, Kyowa Kirin, La Roche Posay, LEO Pharma, L'Oreal, Medexus, MedX, Merck, Novartis, P&G, Pediapharm, Pfizer, Regeneron, Roche, Sanofi Genzyme, Sandoz, Sentrex, Sun Pharmaceutical Industries Limited, TEVA, Tribute, UCB, Viatris, and Volo Health; and has also been a principal investigator for AbbVie, Acelyrin, Akros, Altius, Amgen, Aralez, Arcutis, Avillion, Bausch Health, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Celltrion, Cipher, CoNCERT Pharmaceuticals (subsequently acquired by Sun Pharmaceutical Industries Limited), Dermavant, Devonian, Eli Lilly, Evelo, Galderma, GSK, Incyte, Innovaderm, Intega Skin, Janssen, Kyowa Kirin, La Roche Posay, LEO Pharma, L'Oreal, Medexus, MedX, Merck, MoonLake, Novartis, P&G, Pediapharm, Pfizer, Regeneron, Roche, Sanofi Genzyme, Sandoz, Sentrex, Sun Pharmaceutical Industries Limited, TEVA, Tribute, UCB, Valeant, Viatris, and Volo Health. Dr Zirwas has been an investigator and/or speaker and/or consultant for AbbVie, Acrotech, Aldeyra, Advanced Derm Solutions, All Free Clear/Sun, Amgen, Anaptys Bio, Apogee, Arcutis, Bausch and Lomb, Biocon, Bristol Myers Squibb, Cara, Castle Biosciences, CoNCERT Pharmaceuticals (subsequently acquired by Sun Pharmaceutical Industries Limited), Connect Biopharma, Dermavant, Edessa Biotech, EPI Health, Evelo, Galderma, Genentech/Novartis, Incyte, Janssen, L'Oreal, LEO Pharma, Level-Ex, Eli Lilly, LUUM, Nimbus, Oculus, Peloton, Pfizer, Regeneron/Sanofi, Trevi, Trifecta, and UCB; has also been an advisor for Vial and is part owner of AsepticMD. Dr Maari has served on advisory boards and/or is a consultant and/or is a clinical trial investigator for AbbVie, Almirall, AnaptysBio, Arena Pharmaceuticals, Bristol Myers Squibb, CoNCERT Pharmaceuticals (subsequently acquired by Sun Pharmaceutical Industries Limited), Horizon Therapeutics, Eli Lilly, Incyte Corp., Janssen Pharmaceuticals, LEO Pharma, Pfizer, Regeneron, Sanofi Genzyme, Sun Pharmaceutical Industries Limited, Valeant, Dermavant, Novartis, Amgen, and UCB. Dr Prajapati has been an advisor, consultant, and/or speaker for AbbVie, Actelion, Amgen, Aralez, Arcutis, Aspen, Bausch Health, BioScript Solutions, Boehringer Ingelheim, Bristol Myers Squibb, Canadian Psoriasis Network, Celgene, Cipher, CoNCERT Pharmaceuticals (subsequently acquired by Sun Pharmaceutical Industries Limited), CorEvitas, Eczema Society of Canada, Eli Lilly, Galderma, GlaxoSmithKline, Homeocan, Incyte, Janssen, LEO Pharma, Medexus, Novartis, Pediapharm, Pfizer, Sanofi Genzyme, Sun Pharmaceutical Industries Limited, Tribute, UCB, and Valeant; investigator for AbbVie, AnaptysBio, Arcutis, Arena, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, CoNCERT Pharmaceuticals (subsequently acquired by Sun Pharmaceutical Industries Limited), CorEvitas, Dermavant, Dermira, Eli Lilly, Galderma, Incyte, Janssen, LEO Pharma, Nimbus Lakshmi, Novartis, Pfizer, RAPT Therapeutics, Regeneron, Reistone, Sanofi Genzyme, Takeda, and UCB; received grants from AbbVie, Bausch Health, Janssen, LEO Pharma, Novartis, and Sanofi Genzyme. Dr Sapra has been a principal investigator, consultant, or speaker for AbbVie, Amgen, Arcutis, Avillion, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, CoNCERT Pharmaceuticals (subsequently acquired by Sun Pharmaceutical Industries Limited), Dermavant, Eli Lilly, Galderma, GSK, Incyte, Innovaderm, Janssen, LEO Pharma, Merz, Novartis, Pfizer, Pulse Biosciences, Regeneron, Roche, Sanofi, UCB, and Valeant. Dr Brzewski has been a principal investigator and/or consultant for AbbVie, Acelyrin, Alvotech Swiss, Amgen, BenevolentAI, Bioeq GmbH, Biogen, Celltrion, CoNCERT Pharmaceuticals (subsequently acquired by Sun Pharmaceutical Industries Limited), Eli Lilly, Horizon Therapeutics, Janssen, LEO Pharma, Pfizer, Regeneron, and Samsung Bioepis. Dr Osman has been an advisor for AbbVie, Affibody, Allergan, Amgen, AnaptysBio, Arcutis, Aurigene, Botanix, Castle Biosciences, Chemocentryx, CoNCERT Pharmaceuticals (subsequently acquired by Sun Pharmaceutical Industries Limited), Dermavant, DS Biopharma, Eli Lilly, Foamix Pharmaceuticals, Galderma, Janssen, Incyte, LEO Pharma, Reistone, Sun Pharmaceutical Industries Limited, and Valeant. Dr Hanna has been an advisory board member, principal investigator, investigator, speaker, and/or consultant for AbbVie, Akros, Allergan, Altius Healthcare, Amgen, Aralez, Arcutis, Bausch Health, Biopharma, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Coherus, CoNCERT Pharmaceuticals (subsequently acquired by Sun Pharmaceutical Industries Limited), Cutanea, Dermira, Galapagos, Galderma, Glenmark, Incyte, Janssen, LEO Pharma, Lilly, Lumenis, Merz, Novartis, Pediapharma, Pfizer, Prollenium, Regeneron, Revanesse, Reistone, Sandoz, Sanofi, Sun Pharma, and UCB. Dr Wiseman has been a principal investigator, consultant, advisor, or speaker for Acelyrin, AbbVie (previously Abbott), Akros, Amgen, Arcutis, Asana BioSciences, AstraZeneca, Bausch Health, Bristol Myers Squibb, CoNCERT Pharmaceuticals (subsequently acquired by Sun Pharmaceutical Industries Limited), Celgene, Dermavant, Dermira, Dice, Eli Lilly, Evelo, Galderma, Glenmark, Incyte, Janssen, LEO Pharma A/S, L'Oreal, Merck Frosst Canada, Moonlake, Novartis, Pfizer, Principia, PRCL Research, Regeneron, Sanofi, Takeda, Timber. Drs Hamilton and Cassella are employees of Sun Pharmaceutical Industries, Inc., (Copyright © 2024 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Conflicts of interest Mr Sood, Mr Rimke, Dr Rankin, Dr Abduelmula, Dr Georgakopoulos, Dr Maliyar, and Mr. Bagit have no relevant disclosures. Ms. Fernejoy Leung has been an advisor, consultant, speaker and/or investigator for AbbVie, Arcutis, Bausch Health, BioScript Solutions, Incyte, Janssen, LEO Pharma, Novartis, and UCB. Ms Lauren A. Stark has been an advisor, consultant, speaker and/or investigator for AbbVie, Arcutis, BioScript Solutions, Janssen, and Novartis.Dr Alim R. Devani has been an advisor, consultant, speaker, and/or investigator for AbbVie, Amgen, AnaptysBio, Arcutis, Arena, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Concert, Dermavant, Dermira, Eli Lilly, Galderma, GSK, Incyte, Janssen, LEO Pharma, Medexus, Nimbus Lakshmi, Novartis, Pediapharm, Pfizer, Regeneron, Reistone, Sanofi Genzyme, Sun Pharma, Takeda, Tribute, UCB, and Valeant. Dr Ronald Vender has been an advisor, consultant, speaker, and/or investigator for AbbVie, Actelion, Amgen, Aralez, Arcutis, Astellas, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Cipher, Centocor, Dermira, Dermavant, Eli Lilly, Galderma, GSK, Innovaderm, Janssen, Kabi-Care, LEO Pharma, Merck, Novartis, Palladin, Pfizer, Regeneron, Sandoz, Sun Pharma, Takeda, UCB, and Viatris-Mylan. Dr Jensen Yeung has been an advisor, consultant, speaker, and/or investigator for AbbVie, Amgen, Anacor, Arcutis, Astellas, Bausche, Baxalta, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Centocor, Coherus, Dermira, Forward, Fresenius Kabi, Galderma, Incyte, Janssen, LEO Pharma, Medimmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Sun Pharma, Takeda, UCB, and Xenon. Dr Vimal H. Prajapati has been an advisor, consultant, and/or speaker for AbbVie, Actelion, Amgen, Apogee Therapeutics, Aralez, Arcutis, Aspen, Bausch Health/Valeant, BioScript Solutions, Boehringer Ingelheim, Bristol Myers Squibb, Canadian Psoriasis Network, Celgene, Cipher, Concert, CorEvitas, Eczema Society of Canada, Eli Lilly, Galderma, GlaxoSmithKline, Homeocan, Incyte, Janssen, LEO Pharma, Medexus, Novartis, Pediapharm, Pfizer, Sanofi Genzyme, Sun Pharma, Tribute, and UCB; investigator for AbbVie, AnaptysBio, Arcutis, Arena, Asana, Bausch Health/Valeant, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Concert, CorEvitas, Dermavant, Dermira, Eli Lilly, Galderma, Incyte, Janssen, LEO Pharma, Nektar Therapeutics, Nimbus Lakshmi, Novartis, Pfizer, Regeneron, RAPT Therapeutics, Reistone, Sanofi Genzyme, Sun Pharma, Takeda, and UCB; received grants from AbbVie, Bausch Health, Janssen, LEO Pharma, Novartis, and Sanofi Genzyme.

Competing Interests: Conflicts of interest Dr Mufti has been a speaker for AbbVie and Janssen. Dr Prajapati has been an advisor, consultant, and/or speaker for AbbVie, Actelion, Amgen, Apogee Therapeutics, Aralez, Arcutis, Aspen, Bausch Health/Valeant, BioScript Solutions, Boehringer Ingelheim, Bristol Myers Squibb, Canadian Psoriasis Network, Celgene, Cipher, Concert, CorEvitas, Eczema Society of Canada, Eli Lilly, Galderma, GlaxoSmithKline, Homeocan, Incyte, Janssen, LEO Pharma, Medexus, Novartis, Pediapharm, Pfizer, Sanofi Genzyme, Sun Pharma, Tribute, and UCB; is an investigator for AbbVie, AnaptysBio, Arcutis, Arena, Asana, Bausch Health/Valeant, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Concert, CorEvitas, Dermavant, Dermira, Eli Lilly, Galderma, Incyte, Janssen, LEO Pharma, Meiji Pharma, Nimbus Lakshmi, Novartis, Pfizer, Regeneron, RAPT Therapeutics, Reistone, Sanofi Genzyme, Sun Pharma, Takeda, and UCB; and received grants from AbbVie, Bausch Health, Janssen, LEO Pharma, Novartis, and Sanofi Genzyme. Dr Yeung has been an advisor, consultant, speaker, and/or investigator for AbbVie, Amgen, Anacor, Arcutis, Astellas, Bausche, Baxalta, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Centocor, Coherus, Dermira, Forward, Fresenius Kabi, Galderma, Incyte, Janssen, LEO Pharma, Medimmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Sun Pharma, Takeda, UCB, and Xenon. Authors Sood, Varenbut, Bagit, and Perlmutter, and Drs Maliyar, Sachdeva, Abduelmula, and Georgakopoulos have no conflicts of interest to declare.

Competing Interests: Conflicts of interest Dr Leung has been an advisor, consultant, speaker, and/or investigator for AbbVie, Arcutis, Bausch Health, BioScript Solutions, Incyte, Janssen, LEO Pharma, Novartis, and UCB. Dr Devani has been an advisor, consultant, speaker, and/or investigator for AbbVie, Amgen, AnaptysBio, Arcutis, Arena, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Concert, Dermavant, Dermira, Eli Lilly, Galderma, GSK, Incyte, Janssen, LEO Pharma, Medexus, Nimbus Lakshmi, Novartis, Pediapharm, Pfizer, Regeneron, Reistone, Sanofi Genzyme, Sun Pharma, Takeda, Tribute, UCB, and Valeant. Dr Vender has been an advisor, consultant, speaker, and/or investigator for AbbVie, Actelion, Amgen, Aralez, Arcutis, Astellas, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Cipher, Centocor, Dermira, Dermavant, Eli Lilly, Galderma, GSK, Innovaderm, Janssen, Kabi-Care, LEO Pharma, Merck, Novartis, Palladin, Pfizer, Regeneron, Sandoz, Sun Pharma, Takeda, UCB, and Viatris-Mylan. Dr Yeung has been an advisor, consultant, speaker, and/or investigator for AbbVie, Amgen, Anacor, Arcutis, Astellas, Bausche, Baxalta, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Centocor, Coherus, Dermira, Forward, Fresenius Kabi, Galderma, Incyte, Janssen, LEO Pharma, Medimmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Sun Pharma, Takeda, UCB, and Xenon. Dr Prajapati has been an advisor, consultant, and/or speaker for AbbVie, Actelion, Amgen, Apogee Therapeutics, Aralez, Arcutis, Aspen, Bausch Health/Valeant, BioScript Solutions, Boehringer Ingelheim, Bristol Myers Squibb, Canadian Psoriasis Network, Celgene, Cipher, Concert, CorEvitas, Eczema Society of Canada, Eli Lilly, Galderma, GlaxoSmithKline, Homeocan, Incyte, Janssen, LEO Pharma, Medexus, Novartis, Pediapharm, Pfizer, Sanofi Genzyme, Sun Pharma, Tribute, and UCB; investigator for AbbVie, AnaptysBio, Arcutis, Arena, Asana, Bausch Health/Valeant, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Concert, CorEvitas, Dermavant, Dermira, Eli Lilly, Galderma, Incyte, Janssen, LEO Pharma, Meiji Pharma, Nektar Therapeutics, Nimbus Lakshmi, Novartis, Pfizer, Regeneron, RAPT Therapeutics, Reistone, Sanofi Genzyme, Sun Pharma, Takeda, and UCB; received grants from AbbVie, Bausch Health, Janssen, LEO Pharma, Novartis, and Sanofi Genzyme. Drs Sood, Rimke, Rankin, Abduelmula, Georgakopoulos, Maliyar, and Bagit have no conflicts of interest to declare.

Competing Interests: Conflicts of interest Dr Jensen Yeung has been an advisor, consultant, speaker, and/or investigator for AbbVie, Allergan, Amgen, Arcutis, Astellas, Bausch Health, Boehringer Ingelheim, Bristol Meyers Squibb, Celgene, Centocor, Coherus, Dermavant, Dermira, Forward, Galderma, GlaxoSmithKline, Incyte, Janssen, Kyowa, Leo Pharma, Lilly, Medimmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sandoz, Sanofi Genzyme, Sun Pharma, Takeda, UCB, Valeant (Bausch Health), and Xenon. Dr Vimal H. Prajapati has served as an investigator for AbbVie, Amgen, AnaptysBio, Arcutis, Arena, Asana, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Concert, Dermavant, Dermira, Eli Lilly, Galderma, Incyte, Janssen, LEO Pharma, Nimbus Lakshmi, Novartis, Pfizer, Regeneron, Reistone, Sanofi Genzyme, UCB, and Valeant; he has also served as an advisor, consultant, and/or speaker for AbbVie, Actelion, Amgen, Apogee Therapeutics, Aralez, Arcutis, Aspen, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Cipher, Eli Lilly, Galderma, GlaxoSmithKline, Homeocan, Incyte, Janssen, LEO Pharma, L'Oreal, Medexus, Novartis, Pediapharm, Pfizer, Sanofi Genzyme, Sun Pharma, Tribute, UCB, and Valeant. The remaining authors Dr Georgakopoulos, Mr Sheka, Dr Rankin, Dr Maliyar, and Mr Rimke have no conflicts of interest to declare.

Background: Characterization of upadacitinib use and switching from dupilumab to upadacitinib among patients with moderate-to-severe atopic dermatitis (AD) is needed., Objective: To evaluate the long-term safety and efficacy of continuous upadacitinib 30 mg and switching to upadacitinib after 24 weeks of dupilumab., Methods: Adults who completed the phase 3b clinical trial of oral upadacitinib 30 mg vs injectable dupilumab 300 mg (Heads Up) and entered a 52-week open-label extension (OLE) (NCT04195698) were included. All patients received 30-mg upadacitinib during the open-label period. We report results of a prespecified interim OLE 16-week analysis., Results: Patients (n = 239) continuing upadacitinib maintained high levels of skin and itch response. Patients (n = 245) switching from dupilumab experienced additional incremental improvements in clinical responses within 4 weeks of starting upadacitinib. Most patients who did not achieve adequate clinical responses with dupilumab did so with upadacitinib. The safety profile of upadacitinib up to 40 weeks (week 16 of OLE) was consistent with previous phase 3 AD studies, with no new safety risks observed., Limitations: Open-label study design., Conclusions: Clinical responses are maintained with continuous upadacitinib through 40 weeks and patients regardless of prior dupilumab response experienced improved outcomes when switched to upadacitinib. No new safety risks were observed., Competing Interests: Conflicts of interest Dr Blauvelt has served as a speaker (received honoraria) for AbbVie, Arcutis, Bristol Myers Squibb, Eli Lilly, Pfizer, Regeneron, Sanofi, and UCB. He has served as a scientific advisor (received honoraria) for AbbVie, Abcentra, Affibody, Aligos, Almirall, Alumis, Amgen, Anaptysbio, Arcutis, Arena, Aslan, Athenex, Bluefin Biomedicine, Boehringer Ingelheim, Bristol Myers Squibb, Cara Therapeutics, Dermavant, EcoR1, Eli Lilly, Escient, Evelo, Evommune, Forte, Galderma, HighlightII Pharma, Incyte, InnoventBio, Janssen, Landos, LEO Pharma, Merck, Novartis, Pfizer, Rapt, Regeneron, Sanofi Genzyme, Spherix Global Insights, Sun Pharma, TLL Pharmaceutical, TrialSpark, UCB Pharma, Vibliome, and Xencor. He has been a clinical study investigator (institution has received clinical study funds) for AbbVie, Acelyrin, Almirall, Amgen, Arcutis, Athenex, Boehringer Ingelheim, Bristol Myers Squibb, Concert, Dermavant, Eli Lilly, Evelo, Evommune, Galderma, Incyte, Janssen, LEO Pharma, and Merck. Dr Prajapati has served as an investigator for AbbVie, Amgen, Arcutis, Arena, Asana, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Concert, Dermavant, Dermira, Eli Lilly, Galderma, Incyte, Janssen, LEO Pharma, Nimbus Lakshmi, Novartis, Pfizer, Regeneron, Reistone, Sanofi Genzyme, UCB Pharma, and Valeant. He has served as a consultant, advisor and/or speaker for AbbVie, Actelion, Amgen, Aralez, Arcutis, Aspen, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Cipher, Eli Lilly, Galderma, GlaxoSmithKline, Homeocan, Incyte, Janssen, LEO Pharma, L’Oreal, Medexus, Novartis, Pediapharm, Pfizer, Sanofi Genzyme, Sun Pharma, Tribute, UCB Pharma, and Valeant. Dr Laquer has received honoraria as a consultant from AbbVie, Allos, Aqua, Biogen, Celgene, Eli Lilly, Galderma, Intraderm, LEO Pharma, Mayne, Novartis, and Pfizer. She has served as an investigator for AbbVie, Aiviva, Amgen, Arcutis, Arena, Bellus, Biofrontera, Bristol Meyers Squibb, Cara, Dermavant, Forte, Galderma, Incyte, Kiniksa, Eli Lilly, LEO Pharma, Novan, Novartis, Ortho Dermatologics, Pfizer, Sun Pharma, and UCB. Dr Fischer has served as a principal investigator for AbbVie, UCB, and Eli Lilly. Dr Eisman has served on the Dermatology Advisory Alopecia Areata Board for Eli Lilly and is or has been an investigator in clinical trials for Pfizer Inc, AbbVie, Arena Pharmaceuticals, Boston Pharmaceuticals, Bristol Myers Squibb, Botanix Pharmaceuticals, Dermira, Eli Lilly, Evelo Biosciences, Immunic Therapeutics, Jansen, Kobiolabs, Kymab Ltd, LEO Pharma, Novartis, TEVA Pharmaceuticals, Tigermed Pharmaceuticals, Suzhou Connect Biopharmaceuticals, and Regeneron Pharmaceuticals. Dr Eyerich has served as a speaker, investigator, and/or advisor for AbbVie, Almirall, Berlin Chemie, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Hexal, Galapagos, Janssen, Eli Lilly, Pfizer, Novartis, Sanofi, and UCB Pharma. Drs Ladizinski, Hu, Wu, Calimlim, Kaplan, Y Liu, Teixeira, and J Liu are full-time employees of AbbVie and may hold AbbVie stock or stock options., (Copyright © 2023 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Conflicts of interest Dr Vimal H. Prajapati has been an advisor, consultant, speaker, and/or investigator for AbbVie, Actelion, Amgen, AnaptysBio, Aralez, Arcutis, Arena, Aspen, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Cipher, Concert, Dermavant, Dermira, Eli Lilly, Galderma, GlaxoSmithKline, Homeocan, Incyte, Janssen, LEO Pharma, Medexus, Nimbus Lakshmi, Novartis, Pediapharm, Pfizer, Regeneron, Reistone, Sanofi Genzyme, Sun Pharma, Tribute, UCB, and Valeant. Dr Jensen Yeung has been an advisor, consultant, speaker, and/or investigator for AbbVie, Allergan, Amgen, Astellas, Boehringer Ingelheim, Celgene, Centocor, Coherus, Dermira, Eli Lilly, Forward, Galderma, GSK, Janssen, LEO Pharma, Medimmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Sun Pharma, Takeda, UCB, Valeant, and Xenon. The remaining authors (S.S., M.H., J.G., and A.M.) have no relevant disclosures.

Competing Interests: Conflicts of interest Dr Vender has been a consultant, advisory board member, and investigator for AbbVie, Actelion, Amgen, Astellas, Celgene, Dermira, Eli Lilly, Galderma, Janssen Ortho, Leo, Merck, Novartis, Pfizer, Regeneron, and Takeda. Dr Yeung has been an advisor, consultant, speaker, and/or investigator for AbbVie, Allergan, Amgen, Astellas, Boehringer Ingelheim, Celgene, Centocor, Coherus, Dermira, Eli Lilly, Forward, Galderma, GSK, Janssen, LEO Pharma, Medimmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Sun Pharma, Takeda, UCB, Valeant, and Xenon. Dr Prajapati has been an advisor, consultant, speaker, and/or investigator for AbbVie, Actelion, Amgen, AnaptysBio, Apogee Therapeutics, Aralez, Arcutis, Arena, Aspen, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Cipher, Concert, Dermavant, Dermira, Eli Lilly, Galderma, GlaxoSmithKline, Homeocan, Incyte, Janssen, LEO Pharma, Medexus, Nimbus Lakshmi, Novartis, Pediapharm, Pfizer, Regeneron, Reistone, Sanofi Genzyme, Sun Pharma, Tribute, UCB, and Valeant. Author Abduelmula, Dr Rankin, Author Sood, Dr Georgakopoulos, and Dr Mufti have no conflicts of interest to declare.

Competing Interests: Conflicts of interest Dr Yeung has been an advisor, consultant, speaker, or investigator for AbbVie, Allergan, Amgen, Arcutis, Astellas, Bausch Health, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Centocor, Coherus, Dermavant, Dermira, Forward, Galderma, GlaxoSmithKline, Incyte, Janssen, Kyowa, LEO Pharma, Lilly, Medimmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sandoz, Sanofi Genzyme, Sun Pharma, Takeda, UCB, Valeant (Bausch Health), and Xenon. Dr Gooderham has been an investigator, speaker, or advisor for AbbVie, Amgen, Akros, Arcutis, Bausch Health, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Dermira, Dermavant, Eli Lilly, Galderma, GlaxoSmithKline, Incyte, Janssen, Kyowa Kirin, LEO Pharma, MedImmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Sun Pharma, and UCB. Dr Hong has been an investigator or has received honoraria for advisory board, speaker, and consultant services from AbbVie, Amgen, Bausch Health, Celgene, Dermavant, Eli Lilly, Galderma, GlaxoSmithKline, Janssen, LEO Pharma, Novartis, Pfizer, Regeneron/Sanofi, Sun Pharma, and UCB; and has received research grants for investigator services from AbbVie, Akros, Amgen, Arcutis, Boehringer-Ingelheim, Bristol-Myers Squibb, Celgene, Cutanea, Dermira, Dermavant, DS Biopharma, Eli Lilly, Galderma, GlaxoSmithKline, Janssen, LEO Pharma, Medimmune, Novartis, Pfizer, Regeneron/Sanofi, Roche, and UCB. Dr Lynde has been a speaker or consultant and principal investigator for AbbVie, Altius, Amgen, Aralez, Arcutis, Bausch Health, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Cipher, Dermavant, Eli Lilly, Fresnius Kabi, GlaxoSmithKline, Innovaderm, Intega Skin, Janssen, Kyowa, La Roche Posay, LEO Pharma, L'Oreal, Medexus, Merck, Procter & Gamble, Pediapharm, Regeneron, Roche, Sanofi Genzyme, Sentrex, TEVA, Tribute, UCB, Valeant, Viatris, and Volo Health. Dr Prajapati served as an investigator for AbbVie, Amgen, Arcutis, Arena, Asana, Bausch Health, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Concert, Dermavant, Dermira, Eli Lilly, Galderma, Incyte, Janssen, LEO Pharma, Nimbus Lakshmi, Novartis, Pfizer, Regeneron, Reistone, Sanofi Genzyme, UCB, and Valeant; and as a consultant, advisor, or speaker for AbbVie, Actelion, Amgen, Aralez, Arcutis, Aspen, Bausch Health, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Cipher, Eli Lilly, Galderma, GlaxoSmithKline, Homeocan, Incyte, Janssen, LEO Pharma, L'Oreal, Medexus, Novartis, Pediapharm, Pfizer, Sanofi Genzyme, Sun Pharma, Tribute, UCB, and Valeant. Dr Lansang is or has been an investigator, consultant, speaker, or advisor for AbbVie, Amgen, Bausch, Bristol-Myers, Celgene, Galderma, Janssen, LEO Pharma, Eli Lilly, Novartis, Pfizer, Sandoz, Sanofi, Sun Pharma, and UCB. Dr Turchin served as consultant, speaker, or investigator for AbbVie, Amgen, Arcutis, Aristea, Bausch Health, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Galderma, Incyte, Janssen, Kiniksa, LEO Pharma, Mallinckrodt, Novartis, Pfizer, Sanofi, Sun Pharma, and UCB. Dr Wiseman received honoraria for presentations from AbbVie, Bausch Health, Eli Lilly, Galderma, Janssen, LEO Pharma, Novartis, Pfizer, Sanofi Genzyme, Sun Pharma, and UCB; and for participation to advisory boards from AbbVie, Amgen, Arcutis, Bausch Health, Boehringer Ingelheim International, Bristol Myers Squibb, Celgene, Eli Lilly, Galderma, GlaxoSmithKline, Janssen, LEO Pharma, L'Oreal, Lyceum, Novartis, Pfizer, Sanofi Genzyme, Sun Pharma, and UCB. Dr Jack received grants, contracts, consulting fees, payment or honoraria, or participated on data safety monitoring or advisory board from AbbVie, Amgen, AntibioTx, Arcutis, Asana, Bausch, Boston, Boehringer Ingelheim, Bristol Myers Squibb, Canadian Dermatology Foundation, Cara, Celgene, Concert, Dermavant, Eczema Society of Canada, Eli Lilly, Innovaderm Research, Incyte, Janssen, Kiniksa, LEO Pharma, McGill University Department of Medicine, MITACS, Neokera, Novartis, Pfizer, Ralexar, Sanofi, Sienna, Target PharmaSolutions, Valeant, and UCB. Dr Ramien has consulted for AbbVie, Eli Lilly, LEO Pharma, Pfizer, and Sanofi; and has a registered study with Sanofi. Dr Purdy received payment, honoraria, or participated in advisory boards from AbbVie, Amgen, Arcutis, Bausch, Boehringer Ingelheim, BMS, Eli Lilly, Galderma, Janssen, Johnson & Johnson, LEO Pharma, Pfizer, Sun Pharma, Sanofi, and UCB; and occupied leadership or fiduciary roles in CDA executive and the Eczema Society. Dr Grewal is or has been an investigator, consultant, speaker, advisor for or received research funding or honoraria from AbbVie, Aralez, Amgen, Arcutis, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Cipher, Dermira, Dermtek, Eli Lilly, Galderma, GlaxoSmithKline, Incyte, Johnson & Johnson/Janssen, LEO Pharma, Merck, Novartis, Pfizer, Regeneron, Sanofi, Stiefel, Sun Pharma, Tribute Pharmaceuticals, Takeda, and Vitae.

Competing Interests: Conflicts of interest Dr Vimal H. Prajapati has been an advisor, consultant, speaker, and/or investigator for AbbVie, Actelion, Amgen, AnaptysBio, Aralez, Arcutis, Arena, Aspen, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Cipher, Concert, Dermavant, Dermira, Eli Lilly, Galderma, GlaxoSmithKline, Homeocan, Incyte, Janssen, LEO Pharma, Medexus, Nimbus Lakshmi, Novartis, Pediapharm, Pfizer, Regeneron, Reistone, Sanofi Genzyme, Sun Pharma, Tribute, UCB, and Valeant. The remaining authors have no relevant disclosures.

Competing Interests: Conflicts of interest Dr Prajapati has been an advisor, consultant, speaker, and/or investigator for AbbVie, Actelion, Amgen, AnaptysBio, Aralez, Arcutis, Arena, Aspen, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Cipher, Concert, Dermavant, Dermira, Eli Lilly, Galderma, GlaxoSmithKline, Homeocan, Incyte, Janssen, LEO Pharma, Medexus, Nimbus Lakshmi, Novartis, Pediapharm, Pfizer, Regeneron, Reistone, Sanofi Genzyme, Sun Pharma, Tribute, UCB, and Valeant. Author Abduelmula and Drs Rankin, and Luca have no conflicts of interest to declare.

Competing Interests: Conflicts of interest Dr Devani has been an advisor, consultant, speaker, and/or investigator for AbbVie, Amgen, AnaptysBio, Arcutis, Arena, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Concert, Dermavant, Dermira, Eli Lilly, Galderma, GlaxoSmithKline, Incyte, Janssen, LEO Pharma, Nimbus Lakshmi, Novartis, Pfizer, Regeneron, Sanofi Genzyme, Sun Pharma, Tribute, and UCB. Dr Prajapati has been an advisor, consultant, speaker, and/or investigator for AbbVie, Actelion, Amgen, AnaptysBio, Aralez, Arcutis, Arena, Aspen, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Cipher, Concert, Dermavant, Dermira, Eli Lilly, Galderma, GlaxoSmithKline, Homeocan, Incyte, Janssen, LEO Pharma, Medexus, Nimbus Lakshmi, Novartis, Pediapharm, Pfizer, Regeneron, Sanofi Genzyme, Sun Pharma, Tribute, UCB, and Valeant. Drs Ladha, Rankin, Adly, Stevenson, and Luca have no conflicts of interest to disclose.

Background: Acne is the most frequent adverse event associated with upadacitinib treatment in patients with moderate-to-severe atopic dermatitis., Objective: To characterize the adverse event of acne associated with upadacitinib., Methods: This was a post hoc integrated analysis of 3 phase 3 randomized, double-blind, placebo-controlled trials of upadacitinib, alone (NCT03569293 and NCT03607422) or in combination with topical corticosteroids (NCT03568318). Data included were from the 16-week placebo-controlled period., Results: Over 16 weeks, 84 of 857 (9.8%), 131 of 864 (15.2%), and 19 of 862 (2.2%) patients randomized to receive upadacitinib 15 mg, upadacitinib 30 mg, and placebo, respectively, experienced acne. All cases of acne, except 1, were mild/moderate in severity; 2 patients discontinued treatment due to moderate acne. Acne occurred at higher rates among younger, female, and non-White patients. Acne required no intervention in 40.5% and 46.6% of patients receiving upadacitinib 15 and 30 mg, respectively; most remaining cases were managed with topical antibiotics, benzoyl peroxide, and/or retinoids. Acne also had no impact on patient-reported outcomes., Limitations: This study was relatively short in duration and had a small patient population., Conclusions: Acne associated with upadacitinib for atopic dermatitis treatment is usually mild/moderate in severity and managed with topical therapies or no intervention., Competing Interests: Conflicts of interest Dr Mendes-Bastos has received honoraria for consulting and/or speaker services from AbbVie, Novartis, Janssen, LEO Pharma, Almirall, Sanofi, Viatris, L’Oreal, and Cantabria Labs. He has also worked as a principal investigator in clinical trials supported by AbbVie, Sanofi, and Novartis. Dr Guttman-Yassky is employed by Mount Sinai and is a researcher and/or consultant for AbbVie, Anacor Pharmaceuticals, AnaptysBio, Asana Biosciences, Botanix Pharmaceuticals, Celgene, DBV Technologies, Dermira, Dr Reddy’s Laboratories (Promius Pharma), DS Biopharma, Escalier Biosciences, Galderma, Glenmark, Innovaderm, Janssen, Kyowa Kirin, LEO Pharma, Lilly, MedImmune, Mitsubishi Tanabe Pharma, Novan, Novartis, Pfizer, Ralexar Therapeutics, Regeneron, Sanofi, Stiefel/GlaxoSmithKline, UCB, and Vitae Pharmaceuticals. Ms Jiang, Dr Ladizinski, Dr Liu, Dr Teixeira, and Dr Vigna are full-time employees of AbbVie and may hold AbbVie stock or stock options. Dr Prajapati has served as an investigator for AbbVie, Amgen, Arcutis, Arena, Asana, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Concert, Dermavant, Dermira, Eli Lilly, Galderma, Incyte, Janssen, LEO Pharma, Nimbus Lakshmi, Novartis, Pfizer, Regeneron, Sanofi Genzyme, UCB Pharma, and Valeant. He has served as a consultant, advisor, and/or speaker for AbbVie, Actelion, Amgen, Aralez, Arcutis, Aspen, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Cipher, Eli Lilly, Galderma, GlaxoSmithKline, Homeocan, Janssen, LEO Pharma, L’Oreal, Medexus, Novartis, Pediapharm, Pfizer, Sanofi Genzyme, Sun Pharma, Tribute, UCB Pharma, and Valeant. Dr Simpson has received grants, personal fees, and/or nonfinancial support from AbbVie, Amgen, Arena Pharmaceuticals, BenevolentAI Bio, BiomX, Bluefin Biomedicine, Boehringer Ingelheim, Boston Consulting Group, Collective Acumen, Coronado, Dermira, Evidera, ExcerptaMedica, Forte Biosciences, Incyte, Janssen, Kyowa Kirin, LEO Pharma, Lilly, Medscape, Merck, Novartis, Ortho Dermatologics, Pfizer, Regeneron, Sanofi-Genzyme, SPARC India, Tioga Pharmaceuticals, and Vanda Pharmaceuticals. He has also served on advisory boards for AMAZE, FRED, Harmonising Outcome Measures for Eczema (HOME), Janssen, Kyowa Kirin, LEO Pharma, Lilly, National Eczema Association, NIH MOSS Special Emphasis Panel Study Section, Pfizer, and TARGET PharmaSolutions. Dr Barbarot has received personal fees from AbbVie, Almirall, Janssen, LEO Pharma, Lilly, Pfizer, Sanofi-Genzyme, and UCB; nonfinancial support from Novartis; and grants from LEO Pharma., (Copyright © 2022 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Conflicts of interest Dr Yeung has been an advisor, consultant, speaker, and/or investigator for AbbVie, Allergan, Amgen, Astellas, Boehringer Ingelheim, Celgene, Centocor, Coherus, Dermira, Eli Lilly, Forward, Galderma, GSK, Janssen, LEO Pharma, Medimmune, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, Sun Pharma, Takeda, UCB, Valeant, and Xenon. Dr Vender has been an advisor, consultant, speaker, and/or investigator for AbbVie, Amgen, Boehringer Ingelheim, Celgene, Centocor, Dermira, Eli Lilly, Galderma, GSK, Janssen, LEO Pharma, Merck, Novartis, Pfizer, Regeneron, Sanofi Genzyme, Sun Pharma, Takeda, UCB, and Valeant. Dr Devani has been an advisor, consultant, speaker, and/or investigator for AbbVie, Amgen, Arcutis, Arena, Bausch Health, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Concert, Dermira, Eli Lilly, Galderma, GSK, Incyte, Janssen, LEO Pharma, Novartis, Pfizer, Regeneron, Sanofi Genzyme, Sun Pharma, Tribute, and UCB. Dr Prajapati has been an advisor, consultant, speaker, and/or investigator for AbbVie, Actelion, Amgen, AnaptysBio, Aralez, Arcutis, Arena, Aspen, Bausch Health, Boehringer Ingelheim, Celgene, Cipher, Concert, Dermavant, Dermira, Eli Lilly, Galderma, GSK, Homeocan, Incyte, Janssen, Kymab, LEO Pharma, Medexus, Novartis, Pediapharm, Pfizer, Regeneron, Reistone, Sanofi Genzyme, Sun Pharma, Tribute, UCB, and Valeant. Author Sachdeva and Drs Rankin, Mufti, Luca, Miettunen, and Stevenson have no conflicts of interest to declare.

Background: Psoriasis is a chronic inflammatory disease with clinical manifestations of the skin that affect adults and children. In adults, biologics have revolutionized the treatment of moderate to severe plaque psoriasis where clear or almost clear is a tangible goal. Research on biologics has recently been extended to children. The introduction of these new therapeutic options has outpaced the limited guidelines in this population., Objective: To provide a review of current data on biologics, with a proposal for a clinically relevant treatment algorithm on the management of moderate to severe plaque psoriasis in the pediatric population., Methods: A Canadian panel with expertise in psoriasis, pediatric dermatology, and experience with consensus recommendation processes was selected to review the current landscape of pediatric psoriasis and clinical data on biologics plus identify special considerations for baseline workup and monitoring. Recommendations were reviewed and edited by each expert in an iterative process., Conclusion: A treatment algorithm for moderate to severe plaque psoriasis in pediatric patients is presented, incorporating approved biologics. Guidance on baseline screening and ongoing monitoring is also provided. Ultimately, treatment choice depends on the patient and his or her caregiver, with consideration of comorbidities, impact on quality of life, and relevant safety aspects., (Copyright © 2019 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)