JAKi drive higher super response rates in atopic eczema than methotrexate, despite prior conventional therapy failure

TouchDERMATOLOGY coverage from EADV 2025:

The Atopic Eczema Systemic Therapy Register (A-STAR) is a multicentre observational research study that assesses how children and adults with more severe atopic eczema respond to existing and new systemic treatments in the real world.

At the EADV Congress 2025, held in Paris, France, on 17-20 September, an analysis from A-STAR was presented exploring the association between systemic medications used in patients with atopic eczema and the achievement of super response. We were delighted to speak with Prof. Carsten Flohr (London, UK) to learn more.

The Atopic Eczema Systemic Therapy Register is open in both the UK and the Republic of Ireland, with 57 active sites in the UK and four in Ireland. The study is designed to monitor pharmacovigilance, the safety profiles of systemic therapies, and includes patients who are either initiating or switching to any systemic treatment. These treatments range from conventional drugs such as methotrexate and ciclosporin to advanced therapies including biologics and JAK inhibitors (JAKi).

Alongside safety, treatment effectiveness is a key focus of the register. A detailed health economic evaluation is also embedded, which is particularly relevant in the UK context. The National Institute for Health and Care Excellence (NICE), which provides guidance on the prescribing of systemic therapies in the UK, places particular emphasis on cost effectiveness. The register is therefore able to help, in part, inform their decision making.

We also have a biobank resource built into A-STAR to help us better understand the mechanisms behind treatment response, such as why some patients respond more effectively than others or why certain individuals develop specific side effects.

At the EADV Congress 2025, I presented a ‘super response’ analysis. By this, I mean patients who did particularly well in the context of systemic therapy. In our case, the threshold was set very high, defined as a combined outcome of achieving EASI 90, that is a 90% reduction in disease severity from baseline, together with a quality of life score of 0 or 1 (on a scale with a maximum of 30) and a peak pruritus NRS of 0 or 1, indicating little to no itching, at any time point. We also explored different perspectives of ‘super response’ in an analysis of up to 16 weeks of treatment.

This was a hazard adjusted model for the survival analysis. We calculated hazard ratios and adjusted for potential confounders, including baseline disease severity and the number of systemic therapies patients had previously received.

We found that JAKi, as we know from clinical practice (but nice to reconfirm), achieved better responses compared with biologics, and performed better still, with a higher proportion of patients with atopic eczema achieving super response compared with those receiving conventional systemic drugs such as methotrexate and cyclosporin, despite these treatments mainly being used after failure of conventional systemic medication.

Disclosures: Prof. Carsten Flohr has served as a consultant for Apogee, Almirall, Incyte, LEO, Pfizer and Sanofi; received grant/research support from Sanofi and Pfizer; participated on advisory boards for Apogee, Almirall, Incyte, LEO, Pfizer and Sanofi; participated in the speaker’s bureau with Almirall, Pfizer and Sanofi, and has received honoraria from these companies.

This content has been developed independently by Touch Medical Media for touchDERMATOLOGY. It is not affiliated with the European Academy of Dermatology and Venereology (EADV). Views expressed are the speaker’s own and do not necessarily reflect the views of Touch Medical Media.