First Real-World Snapshot of Abrocitinib in US Atopic Dermatitis Care Reveals Steady Dosing and Strong Persistence

Atopic dermatitis, the chronic inflammatory skin disease better known as eczema, affects millions of Americans with relentless itching, disrupted sleep, and cracked, weeping skin that resists even the most diligent moisturizing routines. For decades, the therapeutic arsenal was limited to topical corticosteroids and crude immunosuppressants, but the last decade has transformed the field with biologics and oral Janus kinase inhibitors. Now, one of the first real-world portraits of how the oral JAK1 inhibitor abrocitinib is actually being used in United States clinics suggests that, outside the tightly controlled environment of clinical trials, the drug is being prescribed conservatively, tolerated well, and maintained at stable doses for long stretches of time.

The study, published in the journal Advances in Therapy, was a retrospective observational analysis drawing on the OMNY Health real-world data platform, which links de-identified electronic health records from dermatology practices and integrated delivery networks with administrative insurance claims. The researchers, led by dermatologist Raj Chovatiya and colleagues, identified 401 patients aged 12 years or older who received their first paid abrocitinib claim between the drug’s US approval dates and October 31, 2025. The linked dataset design matters: claims data alone capture prescriptions but not clinical context, while electronic health records alone miss care delivered outside a single health system. Stitching the two together produces a longitudinal picture with continuity, granularity, and chronology that neither source can offer on its own.

The demographic profile of the cohort revealed some surprises. Adolescents made up just 8.5 percent of patients, while adults accounted for 91.5 percent, with a mean age at initiation of roughly 48 years for adults and 15 years for adolescents. Notably, about a quarter of the study population was aged 65 or older, a proportion the authors attribute partly to the mechanics of data linkage itself: older patients tend to have higher healthcare utilization and more continuous insurance coverage, making them more likely to appear in both the clinical and claims records. Mean time since atopic dermatitis diagnosis was only about four years, strikingly shorter than the more than two decades of disease duration typical of participants in abrocitinib’s pivotal clinical trials, hinting that real-world physicians may be reaching for advanced therapies earlier in the disease course than trial populations would suggest.

The comorbidity burden documented at baseline underscored that atopic dermatitis is far more than a skin condition. Nearly 46 percent of patients were recorded as overweight or obese, 42 percent carried an anxiety diagnosis, and almost 40 percent had allergic rhinitis, reflecting the well-established atopic and psychological comorbidity cluster that travels with the disease. Healthcare resource utilization in the year before starting abrocitinib was substantial: patients averaged nearly 11 outpatient visits annually, along with roughly one emergency or urgent care visit each, and adults consistently used more services than adolescents. These figures quantify the heavy footprint of poorly controlled eczema on the healthcare system even before advanced systemic therapy enters the picture.

Treatment history before abrocitinib told its own story. More than 72 percent of patients had received topical therapies, with topical triamcinolone, oral prednisone, and high-potency clobetasol among the most common prior agents. Yet only about one in five adults and one in three adolescents had previously tried a systemic biologic such as dupilumab. The authors note that these rates of prior systemic therapy were lower than might be expected and may reflect a broader, well-documented pattern of undertreatment in atopic dermatitis, in which patients cycle through topical agents and bursts of oral steroids before escalating to the modern therapeutic options that guidelines now recommend. Strikingly, 72 percent of patients received abrocitinib as their very first advanced systemic therapy, positioning the oral JAK inhibitor as a frontline escalation rather than a last resort.

Dosing patterns emerged as one of the study’s most consequential findings. More than 81 percent of patients initiated abrocitinib at 100 milligrams once daily, the US Food and Drug Administration-approved starting dose, while roughly 15 percent began at 200 milligrams, a dose the FDA currently reserves for patients who do not respond adequately to the lower dose. In contrast, the European Union permits initiation directly at 200 milligrams, and in the real-world-simulating JADE REAL trial, 62 percent of participants started at the higher dose. Patients who began at 200 milligrams in the US cohort were more likely to be male, adolescent, obese, and to have longer disease duration and prior exposure to the oral JAK inhibitor upadacitinib, suggesting clinicians reserve the higher dose for patients perceived as harder to control.

Persistence and dose stability, the practical currencies of real-world drug performance, were impressive. Among patients with at least 12 months of follow-up data, 90.8 percent remained on their original starting dose a full year after initiation, with adolescents showing even higher retention at 96 percent. Early persistence, defined as refilling the prescription within 60 days of the first fill, was achieved by 60.8 percent of patients overall, rising to 70 percent among those starting at 200 milligrams. When dose changes did occur, they typically happened within the first four to five months. These figures exceed the dose-maintenance rates observed in JADE REAL and align closely with a Swedish nationwide cohort that reported 91 percent one-year persistence, painting a consistent international picture of abrocitinib as a therapy patients stay on once they start.

The study was not without blind spots, and the authors are candid about them. Only 49 patients had recorded disease severity assessments using validated instruments such as the itch numerical rating scale, the Investigator Global Assessment, or body surface area measurements, a limitation that mirrors the notoriously sparse documentation of patient-reported outcomes in routine dermatology practice. Among those with recorded scores, roughly 80 percent met criteria for moderate-to-severe disease, broadly consistent with trial populations. The observational design precluded safety analysis, race and ethnicity data were poorly captured, and the convenience sample from providers within a single data platform limits generalizability. The authors also flag that a quarter of the cohort being 65 or older warrants attention, since the abrocitinib prescribing information carries warnings for serious infections, malignancy, cardiovascular events, and thrombosis, all of which increase with age, prompting calls for careful diagnosis confirmation, renal function assessment, vaccination review, and monitoring in older patients.

For a condition that has historically been undertreated and underestimated, the arrival of granular real-world evidence marks a meaningful step forward. The message from this first US-based linked EHR-claims analysis of abrocitinib is one of pragmatic conservatism: physicians are starting most patients at the approved 100 milligram dose, patients are refilling and staying the course, and clinical stability appears achievable for the majority without dose escalation. The authors caution that longer longitudinal studies are still needed to define predictors of response, compare persistence across the growing menu of biologics and JAK inhibitors, and track long-term effectiveness in patients with and without prior biologic experience. But as the therapeutic landscape for atopic dermatitis continues to expand at a dizzying pace, studies like this one provide the ground truth that trials alone cannot: a window into how a new generation of targeted therapies actually performs in the messy, comorbid, real world of American clinical care.

Subject of Research: Real-world prescribing patterns, persistence, and dosing of the oral JAK1 inhibitor abrocitinib in US patients with moderate-to-severe atopic dermatitis

Article Title: Real-World Use of Abrocitinib for Moderate-to-Severe Atopic Dermatitis in the United States Based on Electronic Health Records and Administrative Claims

Article References: Real-World Use of Abrocitinib for Moderate-to-Severe Atopic Dermatitis in the United States Based on Electronic Health Records and Administrative Claims. (n.d.). https://doi.org/10.1007/s12325-026-03761-7

Image Credits: AI Generated

DOI: 10.1007/s12325-026-03761-7

Keywords: abrocitinib, atopic dermatitis, eczema, JAK inhibitors, real-world evidence, electronic health records, administrative claims, drug persistence, dupilumab, dermatology, moderate-to-severe atopic dermatitis, prescribing patterns