Successful treatment of eosinophilic esophagitis with upadacitinib prescribed for atopic dermatitis.

We describe a pediatric patient treated with upadacitinib for atopic dermatitis (AD) who subsequently achieved sustained clinical and histologic remission of eosinophilic esophagitis (EoE). Upadacitinib is an oral small molecule selective Janus kinase 1 inhibitor that inhibits janus kinase-signal transduction and activation of transcription (JAK-STAT) pathway with wide inhibitory effects on the immune system, including Th2 signaling pathways. Therefore, it leads to broad suppression of inflammatory cytokines, including interleukin-4 (IL-4), interleukin-13 (IL-13), and thymic stromal lymphopoietin (TSLP), that play a central role in the pathogenesis of EoE. Given the broad signaling pathway, if a patient is started on upadacitinib for other indications, cessation of other therapies, particularly biologics like dupilumab, should be considered on a case-by-case basis.