Background: Patients with atopic dermatitis (AD) may discontinue dupilumab owing to dupilumab-induced ocular adverse events (DOAEs) or dupilumab-induced facial redness (DFR).
Objective: To evaluate DOAE and DFR outcomes after switching to tralokinumab or Janus kinase inhibitor (JAKi).
Methods: This retrospective study included 106 patients discontinuing dupilumab because of DOAEs and/or DFR. The primary outcome was the proportion of patients with AE resolution or improvement between dupilumab discontinuation (M0) and 3-6 months of tralokinumab or JAKi (M3-M6) treatment; the secondary outcome was the percentage of patients with controlled AD defined by Investigator's Global Assessment (IGA) scores of 0/1 at M3-M6.
Results: Proportions of patients with DOAE (92% vs 72%; p=0.0244) and DFR (85% vs 33%; p=0.0006) resolution or improvement) were higher with JAKi than with tralokinumab. Proportions of patients reaching an IGA score of 0/1 increased from M0 to M3-M6 (22% vs. 42%, p=0.0067) in the JAKi group and remained similar (32% vs. 35%) in the tralokinumab group. However, 57% discontinued the new treatment after 8 months on average, mainly owing to lack of efficacy.
Conclusion: JAKi appears to be more efficient than tralokinumab in managing dupilumab-induced AE; however, both strategies may fail to control AD.
Keywords: Atopic dermatitis; Janus kinase inhibitors; abrocitinib; baricitinib; dupilumab; dupilumab-induced facial redness; dupilumab-induced ocular adverse events; tralokinumab; upadacitinib.
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