Atopic dermatitis relapse after treatment discontinuation and predictive factors for relapse: JAK1 inhibitors versus dupilumab

BACKGROUND AND OBJECTIVES: In the clinical management of atopic dermatitis (AD), treatment discontinuations and subsequent disease relapse are common. Understanding relapse patterns following treatment discontinuation in AD patients is therefore essential. This study aims to investigate the time to relapse and identify predictive factors in patients with moderate-to-severe AD who responded to treatment with selective Janus kinase 1 (JAK1) inhibitors (upadacitinib or abrocitinib) or dupilumab. PATIENTS AND METHODS: This single-center, retrospective cohort analysis reviewed the data for patients aged ≥ 12 years with moderate-to-severe AD who responded to either JAK1 inhibitors or dupilumab within 16 weeks. The primary outcome measures included the median time to skin lesion relapse after treatment discontinuation. Additionally, predictors for relapse were explored. RESULTS: Within 72 weeks after discontinuation, the median time to skin lesion relapse after discontinuation for JAK1 inhibitor and dupilumab responders was 60 and 457 days, respectively. Overall, 52.9% and 34.6% of patients who used JAK1 inhibitors and dupilumab reported AD skin lesion relapse (average hazard ratio = 2.58, 95% confidence interval: 1.25-5.33, p = 0.01). No other factors influencing AD relapse were identified. CONCLUSIONS: After treatment discontinuation, Dupilumab showed relatively longer efficacy than JAK1 inhibitors, resulting in a lower risk of relapse.