Janus kinase inhibitors enhance the efficacy of dupilumab in refractory atopic dermatitis.

OBJECTIVES

Patients with moderate-to-severe atopic dermatitis (AD) often experience intense pruritus and extensive skin lesions, which markedly impair quality of life. Current treatment options, including biologics and small-molecule agents, may provide limited efficacy and are associated with adverse effects. For patients who respond inadequately to dupilumab, particularly those with insufficient control of pruritus, more effective therapeutic strategies are needed. This study aims to evaluate the efficacy, safety, and clinical value of combining dupilumab with Janus kinase inhibitors (JAKis) in the treatment of refractory AD.

METHODS

This retrospective study assessed the efficacy and safety of combination therapy with dupilumab and JAKis in 7 patients with refractory moderate-to-severe AD. Patients received either abrocitinib (100 mg/d) or upadacitinib (15 mg/d) in combination with dupilumab. Disease severity before and after combination therapy was evaluated using the Eczema Area and Severity Index (EASI), Scoring Atopic Dermatitis (SCORAD), Patient-Oriented Eczema Measure (POEM), Dermatology Life Quality Index (DLQI), Itch Numerical Rating Scale (Itch-NRS), and Sleep Disorder Numerical Rating Scale (Sleep-NRS). Adverse events were also recorded.

RESULTS

After 4 weeks of combination therapy, patients with AD who had shown an inadequate response to dupilumab monotherapy exhibited marked improvement in skin lesions. Significant reductions were observed in EASI, SCORAD, POEM, DLQI, Itch-NRS, and Sleep-NRS scores (all P<0.05). All patients achieved an EASI50 (defined as ≥50% reduction in EASI score from baseline) criteria. No serious adverse events were reported, except for one case of mild acne.

CONCLUSIONS

In patients with AD who show an inadequate response to continued dupilumab treatment, the addition of JAKis can significantly enhance therapeutic efficacy and is generally well tolerated. This combination regimen may represent a promising treatment option for refractory AD.