Abstract
OBJECTIVE: This study aimed to evaluate the real-world efficacy and safety of abrocitinib in Chinese patients with moderate to severe atopic dermatitis, while exploring the influence of prior dupilumab treatment on therapeutic outcomes. A single-center retrospective cohort study was conducted at the Department of Dermatology, Shenzhen Second People's Hospital, from July 2022 to December 2024. MATERIALS: A total of 264 patients diagnosed with moderate to severe atopic dermatitis based on the Hanifin-Rajka criteria were enrolled. Participants were categorized into 2 groups: the initial abrocitinib group (n = 168) and the dupilumab-to-abrocitinib switch group (n = 96), depending on their previous exposure to dupilumab therapy. TREATMENT: The initial dose of abrocitinib was administered at 100 mg once daily for the first 12 weeks, followed by a gradual tapering schedule: 100 mg every other day from week 12 to week 36, and 100 mg every third day from week 36 to week 48. For 29 patients showing suboptimal response, the dosage was escalated to 200 mg once daily. METHODS: The primary endpoints included the response rates for EASI-75/90, IGA 0/1 (defined as a reduction of ≥2 points from baseline), and PP-NRS4 at 48 weeks. Safety assessments involved monitoring adverse events (AEs). Statistical analyses were performed using SPSS software, including t-tests, analysis of variance, and chi-square tests. RESULTS: At 48 weeks, the overall response rate for EASI-90 was 42.75%, and the PP-NRS4 response rate was 69.08%. The initial treatment group demonstrated significantly better outcomes compared to the switch group (EASI-90: 47.6% vs. 33.3%, p < 0.05). Regarding safety, 39.02% of patients experienced adverse events, primarily nausea (14.0%) and acne-like rash (11.0%), with no reports of serious adverse events or treatment discontinuation. CONCLUSION: Abrocitinib demonstrates rapid and sustained efficacy, particularly in alleviating pruritus, among Chinese patients with moderate to severe atopic dermatitis. The stepwise dose reduction regimen is both safe and feasible. Patients without prior dupilumab exposure exhibited superior therapeutic responses.