Dupilumab With Concomitant JAK Inhibitor：A Novel Strategy For Atopic Dermatitis With Poor Response To Dupilumab

Background: Atopic dermatitis (AD) is a disturbing, relapsing inflammatory skin disease characterized by recurrent eczema foci and intense itching. Due to the effectiveness and safety of Dupilumab, it is considered a savior for AD patients.Objective: To investigate the efficacy and safety of JAK inhibitors (JAKi) plus Dupilumab therapy in refractory AD patients.Method: An observational study analyzing the disease control status of refractory AD patients under the treatment of Dupilumab. Data on patients with moderate to severe AD treated with Dupliumab were obtained from the First Affiliated Hospital of Wenzhou Medical University. The clinical effectiveness and safety of Dupilumab combined with JAKi were evaluated and monitored.Results: Of the 198 patients enrolled, 56 (28.3%) had underreacted to Dupilumab to dupilumab at 16 weeks. Proportion of patients with an improvement from baseline in the Eczema Area and Severity Index (EASI-75) of at least 75% (65.7%;130/198). Five patients eventually discontinued treatment due to adverse reactions. Among uncontrolled patients (n=51) who did not achieve EASI≤7 or IGA 0/1 during the 16-week study period, 74.5% (38/51) achieved EASI-75 by week 52, including 71.1%(27/38) in combination with JAKi therapy. No significant systemic side effects in the combined JAKi group.Limitations: Including small sample size, short observation period.Conclusion: Given the tremendous burden of AD, the demand for new targeted therapies is very high. The combination of JAKi and Dupilumab in AD patients with low response rates may dramatically changing the treatment expectations of patients and doctors.