ReviewPostepy dermatologii i alergologii2026
Short-term risk and long-term incidence rate of herpes zoster with upadacitinib in patients with atopic dermatitis and psoriatic arthritis: a systematic review and meta-analysis.
Review in Postepy dermatologii i alergologii, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
Introduction: Upadacitinib is a novel selective Janus kinase 1 (JAK1) inhibitor. However, it increases the risk of herpes zoster infection. Aim: We aimed to estimate the short-term risk and long-term incidence rate of herpes zoster in patients with atopic dermatitis (AD) and psoriatic arthritis (PsA) treated with different doses of upadacitinib. Methods: Randomised controlled trials and long-term (≥ 52 weeks) open-label extension studies of upadacitinib for AD and PsA were included. Short-term odds ratios (ORs) and long-term exposure-adjusted event rates (EAERs) for herpes zoster infection were estimated using R software 4.4.3 and STATA 18.0. Results: This review included 8 randomised controlled studies and 11 open-label extension studies. The short-term analysis showed that in AD patients, the ORs for herpes zoster infection after 15 mg and 30 mg upadacitinib were 2.62 (95% CI: 1.06-6.47) and 3.13 (95% CI: 1.38-7.12), respectively. In PsA patients, the ORs were 1.39 (95% CI: 0.45-4.33) and 2.43 (95% CI: 0.96-6.16), respectively. The long-term analysis showed that the EAER for herpes zoster infection in AD and PsA patients using 15 mg upadacitinib was 1 year: 3.87/100 patient-years (PYs), 2 years: 4.68/100 PYs, and 3 years: 4.30/100 PYs; for 30 mg, the EAER was 1 year: 6.96/100 PYs, 2 years: 8.29/100 PYs, and 3 years: 7.53/100 PYs. Upadacitinib 30 mg was associated with a significantly higher risk of herpes zoster compared with 15 mg, with consistent dose-dependent effects at 1-year (OR = 1.78, 95% CI: 1.41-2.24), 2-year (OR = 1.80, 95% CI: 1.28-2.53), and 3-year follow-up (OR = 1.94, 95% CI: 1.59-2.35). Conclusions: Upadacitinib increases the risk of herpes zoster in AD and PsA patients, with a more significant effect in AD patients and a dose-dependent relationship over time.
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