The Revolutionizing Atopic Dermatitis (RAD) 2025 meeting in Nashville, Tennessee, featured a poster presentation on the JADE REAL study, which explored flexible dosing of the JAK1 inhibitor abrocitinib in patients with moderate to severe atopic dermatitis (AD). This global, open-label study aimed to simulate real-world treatment patterns and provide practical insights for clinicians.
Study Overview and Design
The JADE REAL study (NCT04564755) was launched in 2020 and concluded in September 2024. It enrolled 312 patients aged 12 years and older with moderate to severe AD who lacked adequate treatment options. Participants could start on either 100 mg or 200 mg of oral abrocitinib once daily, with the flexibility to adjust the dose based on response and tolerability. The study also allowed concurrent use of topical therapies as needed.
This adaptive design reflects a shift toward individualized therapy, allowing clinicians to escalate or reduce dosage in response to clinical need, rather than adhering to rigid protocols common in randomized controlled trials.
Patient Demographics and Dosing Patterns
Of the 312 participants, 38.5% (n=120) started on 100 mg, while 61.5% (n=192) began with 200 mg of abrocitinib. Younger patients (ages 12–17) and older adults (≥65), as well as those identifying as Black/African American or having moderate AD, were more likely to start on the lower 100 mg dose. In contrast, patients aged 18–64, those identifying as Asian, and individuals with severe AD were more frequently started on 200 mg.
Interestingly, the majority of participants remained on their initial dose throughout the study: 65.0% in the 100 mg group and 62.0% in the 200 mg group. Dose modifications occurred in 35.0% and 38.0% of these groups, respectively, with a small subset undergoing more than one dose change.
Safety and Adverse Events
Treatment-emergent adverse events (TEAEs) led to dose reductions in 8.7% (n=27) of participants and dose escalations in 3.8% (n=12). The most commonly reported TEAEs prompting dose reduction included nausea, thrombocytopenia, acne, fatigue, and folliculitis—each affecting about 1% of the cohort. Notably, atopic dermatitis itself was the only adverse event leading to dose escalation in more than 1% of patients.
These results suggest that while adverse effects were not uncommon, they were generally manageable and infrequently necessitated dose changes. This reinforces the potential of abrocitinib as a viable long-term treatment option, particularly when dosing flexibility is maintained.
Clinical Implications
The JADE REAL study provides a meaningful glimpse into how abrocitinib may be used in everyday clinical practice. Unlike traditional clinical trials, this study incorporated elements designed to mimic real-world use, including variable treatment duration, open-label design, and dose flexibility tailored to individual patient needs.
Key takeaways for clinicians include the relative safety of maintaining patients on their initial dose, the importance of monitoring for TEAEs that may necessitate dose adjustment, and the potential value of flexible dosing to optimize outcomes. The results support abrocitinib’s role as a practical, effective treatment for moderate to severe AD across a wide patient demographic.
Conclusion
The JADE REAL study contributes valuable data to the evolving landscape of AD management. By allowing for dynamic dose adjustments in a real-world–like setting, the study underscores the importance of individualized treatment strategies. As more therapeutic options become available, insights from studies like JADE REAL will be critical in guiding evidence-based, patient-centered care in dermatology.
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