Tralokinumab as a Therapeutic Alternative for Dupilumab-associated Arthralgia in Atopic Dermatitis: A Multi-center Case Series

Abstract

Atopic dermatitis (AD) is a chronic inflammatory skin condition that often requires systemic treatment to achieve optimal clinical outcomes. The clinical and immunological heterogeneity of AD necessitates the use of various therapies to maximize efficacy while minimizing adverse events (AEs). Dupilumab, the first biologic agent approved by the United States Food and Drug Administration (FDA) for moderate-to-severe AD, targets interleukin-4 (IL-4) and interleukin-13 (IL-13) signaling pathways. Although effective, some patients experience dupilumab-associated musculoskeletal AEs, such as arthralgia, arthritis, or enthesitis, which may lead to discontinuation of treatment. Recent studies suggest that IL-4 inhibition disrupts T-cell populations, promoting a skewed T-helper 17 (Th17)-dominant immune response that may contribute to arthralgia. Switching to alternative therapies, such as tralokinumab-an IL-13-specific inhibitor-has shown promise in alleviating these AEs while maintaining control of AD signs and symptoms. Case reports indicate that patients with dupilumab-associated arthralgia have improved after switching to tralokinumab, suggesting the potential of tralokinumab as a safer alternative for these individuals. We present a series of 15 AD patients treated with tralokinumab following discontinuation of dupilumab due to arthralgia. All 15 patients achieved clear or nearly clear skin and demonstrated reductions in AD signs and symptoms as measured by Investigator's Global Assessment (IGA), body surface area of involvement (BSA), and/or patient reported measures of pruritus. Importantly, all patients experienced resolution of arthralgia without recurrence while on tralokinumab. These findings support the use of tralokinumab as an effective and safe alternative therapy for patients with dupilumab-induced arthralgia.

Keywords: Joint pain; adverse event; biologic therapy; eczema; prurigo nodularis.

FIGURE 1.

(A) Clinical images of Patient #7 prior to dupilumab therapy presenting with erythematous, scaly patches on the hands characteristic of atopic dermatitis. She developed arthralgia shortly after starting treatment, prompting discontinuation of dupilumab. (B) Images of the hands of the same patient who demonstrated complete resolution of eczematous patches and arthralgia symptoms after switching biologic treatment to tralokinumab.