Dupilumab in Combination With JAK Inhibitor for Refractory Moderate-to-Severe Atopic Dermatitis

Abstract

Data on combined use of dupilumab and Janus kinases inhibitors (JAKi) in refractory atopic dermatitis (AD) are insufficient, impeding proper head-on comparison. This study aimed to explore the effectiveness and safety of dupilumab in combination with JAKi in real-world settings. A total of 16 patients (8 male and 8 female, aged 5–73) with refractory moderate-to-severe AD receiving 16 weeks of combination treatment of dupilumab and JAKi were included in this study: 7 patients treated with dupilumab and baricitinib 2 mg daily, 5 treated with dupilumab and abrocitinib 100 mg daily, and 4 treated with dupilumab and upadacitinib 15 mg daily. Demographics and disease characteristics at baseline, after 2, 4, 8, 12, and 16 weeks, as well as adverse events, were collected. Significant improvement in clinical scores was achieved in all groups, while no significant difference among the three groups was observed. No adverse events led to treatment discontinuation during the 16-week treatment period. The combination of dupilumab and JAKi could be a novel and favorable option for refractory moderate-to-severe AD, and the recommended doses of the three approved JAKi (baricitinib, abrocitinib, and upadacitinib) as add-on therapy were probably similar in effectiveness. Limited by the absence of comparison between JAKi alone and the combination of the two therapies, the conclusion needed to be further validated.