Outcomes and Predictors of Sustained Response After Dose Tapering of Targeted Therapies in Moderate-to-Severe Atopic Dermatitis: A Systematic Review.

BACKGROUND

Moderate-to-severe atopic dermatitis (AD) often requires prolonged systemic therapy. As disease control is achieved, optimizing dose tapering and identifying factors associated with sustained response are increasingly relevant.

OBJECTIVE

The aim was to identify factors associated with maintained disease control following dose tapering of biologics and small-molecule inhibitors used for AD.

METHODS

A systematic review was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, Embase, and the Cochrane Library were searched from 2010 to present, along with manual reference screening. Studies evaluating dose tapering or withdrawal of dupilumab, tralokinumab, lebrikizumab, abrocitinib, baricitinib, or upadacitinib were included. Extracted data included study design, patient characteristics, tapering or withdrawal strategies, and follow-up duration. Outcomes of interest were sustained response, relapse rates, and predictors of long-term disease control.

RESULTS

Nineteen studies (4375 patients) were included. Sustained response rates post-tapering varied across abrocitinib (0-60%), baricitinib (45-61%), dupilumab (30-100%), lebrikizumab (67-82%), tralokinumab (25-50%), and upadacitinib (47-61%). Lower baseline disease activity and early clinical improvement were frequently identified as potential predictors of durability. For dupilumab, older age, lower body mass index (BMI), and prurigo nodularis phenotype were associated with sustained response in selected cohorts. For tralokinumab, longitudinal stability across multiple visits outperformed single-time-point assessments. Abrocitinib outcomes favored milder disease without allergic comorbidities, whereas upadacitinib showed higher relapse rates after withdrawal.

CONCLUSIONS

In selected patients with moderate-to-severe AD achieving stable disease control, dose tapering appeared to preserve efficacy more frequently than abrupt withdrawal, although response rates and durability varied across therapeutic classes, study designs, and outcome definitions. Predictors of sustained response were drug specific, and longer prospective studies are needed to inform individualized tapering strategies.