Combination of Abrocitinib and Dupilumab Effectively Treats Pediatric Atopic Dermatitis

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In a recent clinical trial, investigators found that the combined use of dupilumab and abrocitinib was successful in managing pediatric atopic dermatitis.¹ The researchers found that the administration of these 2 treatments reduced flare-ups and improved the patients’ quality of life. This report is the first of its kind in children with severe, refractory AD.

A total of 3 pediatric patients were involved in the study and each had exhausted all typical treatments for AD, including dupilumab and abrocitinib individually but never in tandem, prior to the trial. Each child received 200 mg of dupilumab every two weeks and 200 mg of abrocitinib each day. To measure results, researchers noted each participant’s Eczema Area and Severity Index (EASI) and Children's Dermatology Life Quality Index (cDLQI) scores. Although both treatments are monoclonal antibodies, dupilumab is an interleukin (IL)-4 and IL-13 inhibitor administered via injection while abrocitinib is an oral JAK inhibitor.

Patient 1 was a 13-year-old female with severe, infantile-onset AD, treated from 2020 to 2023. She had a pre-treatment EASI of 40.1 and a cDLQIof 15. The patient began taking 200 mg of dupilumab and did not have any adverse effects. Abrocitinibwas later added to her regimen and she saw significant improvement within a month. At the 8-week mark, her EASI was a 9.9 and her cDLQI was a 6. Her symptoms remained controlled 12 months after the combined treatment.

Patient 2 was a 15-year-old female with severe childhood-onset AD, treated from 2019 to 2021. She had a baseline EASI of 25 and a cDLQI of 8. Throughout the study, the patient was given a changing treatment plan of cyclosporine, dupilumab, methotrexate, and abrocitinib, which only resulted in some improvement and caused adverse effects such as nausea. She was then given the combination of dupilumab and abrocitinib, and the disorder has been well-controlled since. Her latest scores were an EASI of 7.7 and a cDLQI of 6.

Patient 3 was a 13-year-old male with severe childhood-onset AD and comorbid alopecia aerate, treated from 2020 to 2022. His baseline EASI was 26.2 while his cDLQI was 22. The patient had limited response to past treatments and had suffered from adverse events such as nausea, weight loss, and anxiety/depression. Dupilumab treatment was initially stalled due to the child’s phobia of needles. However, once treated with the combination therapy, the AD has been well controlled (EASI 8, cDLQI 8).

Overall, the combined use of dupilumab and abrocitinib significantly increased disease stability and clinical improvement in all 3 patients. Participants experienced less itching, skin flares, and other AD symptoms, minimizing discomfort and improving their quality of life. These findings align with what was found in a previous study, testing the same treatment combination on adults with AD.²

The researchers noted that this treatment strategy may not be suitable for every patient at this time, especially since this trial involved a relatively small sample size.

“Obtaining access for even one of these agents is difficult, and obtaining coverage for both in combination may be an even more arduous task often involving extensive documentation, persistent follow-ups, and multidisciplinary discussion,” the authors wrote. “Indeed, this was our experience for the three cases.”

Despite that hurdle, the benefits of this treatment strategy could be very valuable to children with AD. The grouping of dupilumab and abrocitinib may provide a more effective and personalized approach to treatment. Further studies are needed to test the long-term safety and benefits of this regimen.

References

1. Fong WCG, Kaung HHW, Lopes R, et al. A Case Series of Refractory Pediatric Atopic Dermatitis Effectively Treated with Dupilumab in Combination with Abrocitinib. Pediatr Dermatol. Published online October 3, 2024. doi:10.1111/pde.15761

2. Yang N, Chen L, Shao J, Jiang F, Liu J, Li Z. Dupilumab with concomitant Janus kinase inhibitor: a novel treatment strategy for atopic dermatitis with poor response to dupilumab. Br J Dermatol. 2022;187(5):828-830. doi:10.1111/bjd.21776