D3.307 - Experience with Systemic Emergent Therapies for Moderate-to-Severe Atopic Dermatitis: Insights from an Allergy and Clinical Immunology Department

Dupilumab and janus kinase (JAK) inhibitors revolutionized the treatment of patients with moderate-to-severe atopic dermatitis (AD). In this study, we aim to describe our department’s experience in the treatment of patients with moderate-to-severe AD, with these drugs.

Retrospective analysis of the clinical data of patients treated with dupilumab, baricitinib and upadacitinib primarily for AD, at our Allergy and Clinical Immunology Department.

A total of 42 patients were treated for AD: 38 with dupilumab, 3 with baricitinib, and 2 with upadacitinib. The median duration of therapy was 24 (IQR:19-40) months. The median age was 25 (IQR:19-33) years, with 9 patients in the pediatric range. A female predominance (69%) was observed.  Considering comorbidities, 34 (83%) had allergic rhinitis, 22 (52%) asthma and 11 (26%) food allergy. Previous treatments included systemic corticosteroids (95%), cyclosporine (74%), azathioprine (10%) and methotrexate (1 patient). At baseline, mean EASI and SCORAD were 28.87 (±11.40) and 68.80 (±15,36), respectively.

In the dupilumab-treated group, a significant improvement in median SCORAD was observed at 3, 12 and 24 months of treatment. It was possible to extend dosage intervals in 14 patients (3 weeks in 6, 4 weeks in 6 and 5 weeks in 2 patients). Self-administration at home was feasible for 34 patients (89%). Conjunctivitis was reported in 6 (16%) patients, leading to drug discontinuation in 1 (switched to upadacitinib). 

Among the 3 patients receiving baricitinib, 2 showed a good clinical response without reported side effects, while 1 discontinued treatment after three months due to inefficacy.

For upadacitinib, 1 patient was previously treated with dupilumab and demonstrated clinical improvement within three weeks, with a sustained response. The other patient has been receiving this medication for only two months. No side effects were reported.

The described data corroborate that dupilumab is a safe and effective treatment in AD. JAK inhibitors present promising results. Biomarkers are still necessary for determining the most appropriate treatment option. 

The study's retrospective nature and small sample size prevented assessing treatment impact on quality of life, comorbidities, or their influence on treatment response.

An uniformized protocol for reassessing patients following therapy introduction is lacking. The ideal timing for dose reduction in controlled AD is also unknown.