PA02 A case series of refractory, paediatric atopic dermatitis effectively treated with dupilumab in combination with abrocitinib

A range of systemic treatment options are available for children with atopic dermatitis (AD) who do not respond to standard topical therapy. However, real-world data have revealed a subset of patients who remain significantly affected despite treatment with all of the available topical and systemic therapies, including novel therapeutic agents such as dupilumab and Janus kinase (JAK) inhibitors. To achieve disease control, these individuals may require novel approaches such as utilizing systemic treatments in combination. However, there is insufficient published evidence about the efficacy and safety of this approach. We present three paediatric cases with severe refractory AD who required combined systemic therapy with dupilumab and abrocitinib to achieve adequate disease control and improvement in quality of life. The third patient had coexistent extensive alopecia areata, which also responded well to treatment. These individuals had exhausted all conventional systemic therapies, and had undergone treatment with both dupilumab and abrocitinib individually and in various combinations with methotrexate. However, despite this, they continued to experience inadequate disease control and significant adverse effects. It was only when the combination of dupilumab and abrocitinib was introduced that they finally achieved noticeable and sustained improvements in AD control. The heightened observed efficacy of dupilumab and abrocitinib in combination may be attributed to the inhibition of interleukin-4 and interleukin-13 at two separate stages, at the receptor (dupilumab) and intracellularly (abrocitinib). Furthermore, an additional advantage of this combined regimen is that JAK inhibitors, with their broader mechanism of action, may attenuate cytokines implicated in comorbid diseases such as dupilumab-related eye disease, seen in our first two cases, and alopecia areata in our third case. In conclusion, the concurrent use of dupilumab with abrocitinib represents a potentially effective and tolerated therapeutic approach for children with severe, refractory AD who exhibit inadequate control with other treatments. Larger studies are warranted to ascertain the long-term efficacy and safety of this treatment strategy.