Switching From Dupilumab to Tralokinumab or Janus Kinase Inhibitors in Cases of Ocular and/or Facial Adverse Events in Patients With Atopic Dermatitis: A Multicenter Retrospective Study

Abstract

Background: Patients with atopic dermatitis (AD) may discontinue dupilumab owing to dupilumab-induced ocular adverse events (DOAEs) or dupilumab-induced facial redness (DFR).

Objective: To evaluate DOAE and DFR outcomes after switching to tralokinumab or Janus kinase inhibitor (JAKi).

Methods: This retrospective study included 106 patients discontinuing dupilumab because of DOAEs and/or DFR. The primary outcome was the proportion of patients with resolution of adverse events or improvement between dupilumab discontinuation (M0) and 3 to 6 months of tralokinumab or JAKi (M3-M6) treatment; the secondary outcome was the percentage of patients with controlled AD defined by Investigator's Global Assessment scores of 0/1 at M3 to M6.

Results: Proportions of patients with DOAE (92% vs 72%; P = .0244) and DFR (85% vs 33%; P = .0006) resolution or improvement were higher with JAKi than with tralokinumab. Proportions of patients reaching an Investigator's Global Assessment score of 0/1 increased from M0-M3 through M6 (22% vs 42%; P = .0067) in the JAKi group and remained similar (32% vs 35%) in the tralokinumab group. However, 57% discontinued the new treatment after 8 months on average, mainly owing to lack of efficacy.

Conclusions: Janus kinase inhibitor appears to be more efficient than tralokinumab in managing dupilumab-induced AE; however, both strategies may fail to control AD.

Keywords: Abrocitinib; Atopic dermatitis; Baricitinib; Dupilumab; Dupilumab-induced facial redness; Dupilumab-induced ocular adverse events; Janus kinase inhibitors; Tralokinumab; Upadacitinib.