Outcomes and Predictors of Sustained Response After Dose Tapering of Targeted Therapies in Moderate-to-Severe Atopic Dermatitis: A Systematic Review.

In 30 seconds

This systematic review examined dose tapering or withdrawal of biologics and small-molecule inhibitors in moderate-to-severe atopic dermatitis (AD), including 19 studies and 4375 patients. Sustained response after tapering varied substantially by therapy: 0-60% for abrocitinib, 45-61% for baricitinib, 30-100% for dupilumab, 67-82% for lebrikizumab, 25-50% for tralokinumab, and 47-61% for upadacitinib. Lower baseline disease activity and early clinical improvement were frequently associated with durable control. The review concluded that tapering appeared to preserve efficacy more often than abrupt withdrawal in selected patients with stable disease.

Key findings

• Sustained response rates after tapering ranged from 0-60% for abrocitinib to 67-82% for lebrikizumab, with substantial variation across therapies.
• Lower baseline disease activity and early clinical improvement were frequently identified as potential predictors of sustained control.
• Upadacitinib was associated with higher relapse rates after withdrawal.
• For tralokinumab, stability across multiple visits predicted durability better than a single-time-point assessment.

Why it matters

The findings suggest that dose reduction may be feasible for some patients whose AD is stably controlled, but outcomes differ by drug and patient characteristics. Recognizing potential predictors may help frame discussions about tapering and monitoring, while the wide range of response rates underscores that durable control after dose reduction cannot be assumed.

What to keep in mind

The review included studies with varying designs and outcome definitions, and response rates differed widely. The authors note that longer prospective studies are needed.