Efficacy of abrocitinib in patients with atopic dermatitis resistant to Janus kinase inhibitors

Abrocitinib, a selective Janus kinase 1 (JAK1) inhibitor, has demonstrated efficacy in moderate-to-severe atopic dermatitis (AD), although data in patients whose AD is resistant to multiple systemic therapies remain limited. We report the case of six patients with moderate-to-severe AD who were unresponsive to previous treatments, including dupilumab, tralokinumab, lebrikizumab, upadacitinib and/or baricitinib. All patients received abrocitinib 200 mg daily. After only 16 weeks, five patients achieved a good clinical response, defined as an Eczema Area Severity Index score of ≤7 and a reduction of ≥3 points in the itch Numerical Rating Scale; in three patients, this response was maintained through 32 weeks. Two patients discontinued abrocitinib due to primary or secondary inefficacy. No serious adverse events were reported; only one patient experienced mild increases in cholesterol and triglyceride levels. These findings suggest that patients with difficult-to-treat AD may benefit from therapy with abrocitinib, potentially due to its high selectivity for JAK1, which may explain its efficacy where other JAK inhibitors have failed.