Durability of Response After Pausing Abrocitinib Treatment in Patients With Moderate-to-Severe Atopic Dermatitis

Objective The heterogeneous nature of atopic dermatitis (AD) necessitates flexibility in tailoring treatment regimens to manage changes in the signs and symptoms of AD over time. Abrocitinib, an oral Janus kinase 1–selective inhibitor, is approved for the treatment of adults and adolescents with moderate-to-severe AD. The objective of this study was to assess durability of response after treatment interruption in patients with moderate-to-severe AD receiving abrocitinib. Methods This analysis included patients from JADE REGIMEN (NCT03627767) who received abrocitinib 200 mg for 12 weeks, were responders (Investigator’s Global Assessment [IGA] score of 0/1 with ≥2-point reduction from baseline and ≥75% improvement from baseline in Eczema Area and Severity Index [EASI-75]), and then received placebo for 40 weeks. In case of flare (≥50% loss of initial EASI response at Week 12 with a new IGA score ≥2), patients restarted abrocitinib as rescue therapy (abrocitinib 200 mg plus topical therapy) for 12 weeks. Patients then entered an ongoing long-term extension study (JADE EXTEND [NCT03422822]; data cutoff: September 5, 2022) and were randomly assigned to abrocitinib 200 mg or 100 mg. Assessments included EASI-75 and ≥90% improvement from baseline in EASI (EASI-90). Missing data were handled with nonresponder imputation (NRI). Results Of 234 responders who were randomized to placebo and entered EXTEND, 42 (18%) did not have flares on placebo for 40 weeks: of these, 16 and 26 then received abrocitinib 200 mg and 100 mg in EXTEND, respectively. Of patients who had flares and received rescue therapy, 49 and 143 received abrocitinib 200 mg and 100 mg in EXTEND. Of flare-free patients, 93.8%/68.0% (200 mg/100 mg) and 81.3%/48.0% achieved EASI-75 and EASI-90, respectively, at last assessment on placebo; 87.5%/60.0% and 75.0%/56.0% maintained response (NRI) at 48 weeks after restarting abrocitinib. Of patients who had flares, 97.8%/94.3% (200 mg/100 mg) and 73.9%/82.9% achieved EASI-75 and EASI-90, respectively, at Week 12 of rescue therapy; 76.6%/59.3% and 72.3%/41.4% maintained response (NRI) at 96 weeks after initiating rescue therapy. Conclusion For some patients receiving abrocitinib treatment, treatment may be interrupted without these patients experiencing a loss of response. In case of flare, restarting abrocitinib is an effective, fast rescue therapy. Restarting abrocitinib treatment showed good response at either dose, although response rates were numerically higher with abrocitinib 200 mg.