D2.464 - Stapokibart (anti–IL-4Rα monoclonal antibody) across type 2 inflammatory diseases in routine practice: a three-case series of severe atopic dermatitis, chronic urticaria with rhinosinusitis, and immune-related bullous pemphigoid

Background: Type 2 inflammation contributes to multiple allergic and inflammatory disorders and may present with multimorbidity. We report three cases treated with stapokibart (anti–IL-4Rα monoclonal antibody).

Methods: We retrospectively summarised three consecutive patients managed in a tertiary centre: (i) severe atopic dermatitis (AD); (ii) chronic urticaria with rhinosinusitis and sinus inflammation on imaging; and (iii) bullous pemphigoid (BP) developing during cancer therapy. Stapokibart was initiated with 600 mg and continued as 300 mg every 2 weeks; in case 3, a second 600-mg dose was given on day 8 before 300-mg dosing. Adverse events were recorded.

Results: Case 1 (27 years, AD) had persistent disease despite dupilumab, abrocitinib and upadacitinib. After stapokibart, Eczema Area and Severity Index (EASI) decreased from 61 to 14 at week 10 and to 6 at week 19; body surface area (BSA) from 70 to 40 to 20; and peak pruritus numerical rating scale (PP-NRS) from 9 to 4 to 2; no adverse events were reported. Case 2 (19 years, chronic urticaria) completed five injections; wheals markedly improved with only occasional flares during environmental changes, nasal obstruction was stable, and follow-up imaging showed reduced maxillary and sphenoid sinus effusion and improved mucosal thickening. Case 3 (70 years, BP) received stapokibart with oral methylprednisolone taper; BP180 decreased from 191.5 RU/mL at baseline to 29.6 on day 8, 20.5 on day 22, and 14.9 on day 36 with clinical improvement; no new safety signals were reported.

Conclusions: In this three-case series, stapokibart was associated with improvement across distinct type 2 inflammatory phenotypes, including difficult-to-treat AD and therapy-associated BP with a parallel serological response. Prospective studies are needed to define predictors of response, positioning with concomitant therapies and safety in complex comorbid settings.