Highlight
- Abrocitinib tapering over 24 weeks in moderate-to-severe atopic dermatitis (AD) patients is feasible, achieving 97.4% successful tapering rate.
- Two tapering regimens (dose reduction vs interval extension) showed good efficacy but interval extension had higher rates of strategy switching due to disease fluctuation.
- Tapering resulted in nearly 41% reduction in cumulative abrocitinib dose and significant cost savings while maintaining clinical response.
Study Background
Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by intense pruritus and eczematous lesions, often significantly impairing quality of life. Moderate-to-severe cases frequently require systemic therapies. Janus kinase (JAK) inhibitors such as abrocitinib have emerged as effective treatments, rapidly controlling symptoms and skin inflammation. However, continuous full-dose use of JAK inhibitors raises concerns about long-term safety, costs, and treatment burden. Despite achieving adequate clinical response, evidence guiding dose tapering strategies remains limited, and no head-to-head comparisons of tapering regimens have been reported. This study addresses these critical knowledge gaps by evaluating the real-world feasibility and comparative outcomes of two 24-week abrocitinib tapering approaches in moderate-to-severe AD.
Study Design
This retrospective single-center study enrolled 78 patients with moderate-to-severe AD who achieved adequate clinical response on abrocitinib and subsequently underwent a 24-week tapering protocol. Patients were grouped by tapering regimen: dose reduction (n=36) versus interval extension (n=42). Dose reduction involved lowering the daily abrocitinib dose, while interval extension involved maintaining dose strength but increasing dosing intervals. Primary endpoints were successful tapering rates and relapse-free survival at 12 and 24 weeks. Secondary endpoints included cumulative drug dose, cost savings, and rate of regimen strategy switching due to disease fluctuation.
Key Findings
Successful tapering was achieved in 97.4% (76/78) of patients overall. Nonrelapse rates were high, at 97.4% at 12 weeks and 91.0% at 24 weeks. These findings support the feasibility of maintaining disease control during tapering in well-responding patients.
The mean cumulative abrocitinib dose over 24 weeks was significantly reduced by 9892 mg compared to projected standard-dose treatment (6908 mg versus 16,800 mg). This dose reduction translated into substantial cost savings of ¥2899.5 on average per patient (¥2016.7 versus ¥4916.2 projected with standard dosing).
Comparing tapering regimens, patients undergoing interval extension had a statistically higher rate of strategy switching due to disease fluctuations (28.6% vs 8.3%, P = .041). This suggests that while both methods can be effective, dose reduction may provide greater disease stability during tapering. No serious adverse events or safety concerns were reported in either group over the follow-up period.
Expert Commentary
The findings presented by Deng et al. provide valuable insights into deescalation strategies for JAK inhibitors in AD, a domain where limited guidance exists. Retaining efficacy while reducing dose exposure is crucial to mitigate potential long-term risks and reduce financial burden. The head-to-head comparison indicates a preference for dose reduction as a tapering strategy to minimize treatment interruptions or need for regimen adjustments. This aligns with the pharmacokinetic profile of abrocitinib, where steady plasma concentrations may better sustain disease control.
Limitations include the retrospective design, relatively small cohort, single-center setting, and limited 24-week follow-up, all of which affect generalizability and long-term outcome assessment. Prospective randomized trials are warranted to confirm these results and define optimal tapering schedules for various patient subgroups.
Conclusion
In moderate-to-severe AD patients who have achieved adequate response to abrocitinib, tapering the medication over 24 weeks is a feasible and effective strategy to reduce cumulative dose and costs while maintaining disease control. Dose reduction tapering regimens appear more stable compared to interval extension, suggesting their preferential use in clinical practice. This study supports personalized, stepwise deescalation of JAK inhibitor therapy to balance efficacy, safety, and economic considerations, addressing key unmet needs in AD management.
Funding and ClinicalTrials.gov
No information on funding or clinical trial registration was reported in the study.
References
1. Deng S, He Y, Wang H, Chen Q, Gao C, Song Z. Real-world outcomes of 24-week abrocitinib tapering in moderate-to-severe atopic dermatitis: Feasibility and regimen comparison. J Am Acad Dermatol. 2026 Jul 9; PMID: 42423580.
2. Silverberg JI, et al. Safety and efficacy of oral JAK inhibitors in the treatment of atopic dermatitis: A review of clinical trials. J Allergy Clin Immunol Pract. 2023;11(1):131-142.
3. Kim B, Silverberg JI. Systemic pharmacologic treatments for atopic dermatitis: A systematic review. JAMA Dermatol. 2020;156(12):1397–1410.
4. Papadopoulos L, et al. Dose tapering in biologics and small molecules: Clinical experience and guidelines in atopic dermatitis. Dermatol Ther. 2022;35(10):e15755.