Effectiveness and Safety of JAK Inhibitors in Patients With Atopic Dermatitis Unresponsive Versus Naïve to Dupilumab: A Multicentric Real-World Retrospective Study

Introduction: Janus kinase (JAK) inhibitors are novel therapies for atopic dermatitis (AD); however, only limited data exist on their effectiveness in patients with previous failures in biological treatment.

Methods: Patients with moderate-to-severe AD and having completed a minimum of 16 weeks of JAK inhibitor therapy were divided into subgroups based on prior dupilumab exposure: those without prior exposure and those whose treatment was discontinued due to lack of efficacy (dupilumab nonresponders [DNR]). Eczema Area and Severity Index (EASI), DLQI, and Itch Numeric Rating Scale (Itch NRS) changes from baseline were assessed in Weeks 16 and 24 (when available). Adverse events during the follow-up were recorded.

Results: In total, 241 patients were included; 148 received upadacitinib (99 dupilumab-naïve, 49 post-dupilumab failure), 47 were with baricitinib (32 dupilumab-naïve, 15 post-dupilumab failure), and 46 received abrocitinib (35 dupilumab-naïve, 11 post-dupilumab failure). At Week 16, an EASI-75 response in the upadacitinib group was achieved in 86% naïve versus 82% DNR patients, 91% naïve versus 73% DNR patients in the abrocitinib group, and 81% naïve versus 67% DNR in the baricitinib group. Itch NRS ≥ 4-point reduction was achieved in 82% naïve versus 76% DNR patients on upadacitinib, 83% naïve versus 91% DNR patients on abrocitinib, and 72% naïve versus 40% DNR patients on baricitinib.

Conclusion: In conclusion, our retrospective analysis suggests that previous dupilumab failure did not significantly affect the short-term effectiveness of JAK inhibitor therapy for AD.