JAK-inhibitors as rescue therapy in dupilumab-refractory severe atopic dermatitis: A case series of 6 patients
Abstract
AD: atopic dermatitis BSA: body surface area IGA: investigator’s global assessment IL: interleukin JAK-I: JAK-inhibitor INTRODUCTION Atopic dermatitis (AD) is a chronic, relapsing, inflammatory skin disorder with a heterogeneous clinical presentation and the cardinal symptom of itch, that results in significant patient burden and a significant decrease in patient’s quality of life. The pathogenesis of AD is multifactorial and results from an immune response skewed toward the Th2 axis, displaying upregulation of key cytokines, including interleukin 4 (IL-4), IL-5, IL-13, and IL-31. Dupilumab, a biologic, which inhibits IL-4 and IL-13 signaling via the inhibition of the IL-4 receptor alpha subunit, was the first targeted treatment approved for AD. More recently, the inhibition of the JAK-STAT pathway with drugs, such as tofacitinib, baricitinib, upadacitinib, and abrocitinib, has shown effectiveness in AD, with the latter 2 gaining U.S. Food and Drug Administration approval in 2022. Although dupilumab is highly effective and used as monotherapy, it might insufficiently treat the signs and symptoms of AD for some patients, necessitating the use of adjunctive therapy. In fact, a single case report has shown a positive response to tofacitinib rescue therapy in a patient who was inadequately controlled with dupilumab monotherapy. Here, we report 6 patients with severe AD who positively responded to an adjunctive JAK-inhibitor (JAK-I) in the setting of inadequate dupilumab…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health. Reported size: 6 participants or records.
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