Therapeutic Outcomes Across JAK Inhibitors in Prurigo Nodularis

Background: Prurigo nodularis (PN) is a debilitating skin condition. When inadequate disease control is achieved or other systemic therapies are contraindicated, JAK inhibitors may be considered although real-world evidence remains limited. Objective: To investigate clinical findings and treatment outcomes among patients diagnosed with PN and undergoing JAK inhibitors in real-world setting. Methods: Retrospective cohort study across 23 Italian tertiary referral hospitals. PN Patients were eligible if aged ≥ 18 years and had received a JAK inhibitor with a minimum follow-up of 12 weeks. The primary outcome was defined as the proportion of patients achieving a reduction of ≥4 points from baseline in PP-NRS score. Key secondary outcomes included the rates of patients reaching a significant reduction in IGA PN-S and IGA PN-A scores. Results: Seventy-one patients met the inclusion criteria. At week 16, the proportion of patients achieving the primary outcome was 94.5% for upadacitinib (n=52/55; 95% CI, 87%-100%), 83.3% for abrocitinib (n=10/12; 95% CI, 52%-98%), and 100% for baricitinib (n=4/4; 95% CI, 40%-100%) with results sustained at week 24. IGA PN-A score of 0/1 was achieved in 90% of patients treated with upadacitinib and abrocitinib, and in 50% of those on baricitinib by week 24. Improvements were observed across all other secondary outcomes assessed, with no safety concerns reported. Conclusions: This study suggests that JAK inhibitors achieve clinically meaningful outcomes in PN irrespective of atopic background, supporting their use across diverse patient profiles. Further research is warranted to validate these observations and explore their long-term effects.