Clinical Assessment of Abrocitinib, Tofacitinib, and Cyclosporine in Adult Patients With Moderate to Severe Atopic Dermatitis: A Retrospective Analysis

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BACKGROUND: Moderate to severe atopic dermatitis (M2S AD) is a chronic, relapsing inflammatory skin disease characterized by intense pruritus and eczematous lesions with significant impact on quality of life. Conventional therapies like cyclosporine are commonly prescribed drugs, along with tofacitinib as an off-label use. Recently, abrocitinib received approval for the management of M2S AD, a selective JAK1 inhibitor that has been well studied in the Western population. However, real-world comparative data among cyclosporine, tofacitinib, and abrocitinib remain limited. Therefore, we conducted a retrospective single-center study to assess the effectiveness and safety of cyclosporine, tofacitinib, and abrocitinib in adult patients with M2S AD over a 16-week treatment period. MATERIALS AND METHODS: A single-center retrospective cohort study was conducted using electronic medical records of adult M2S AD patients treated with abrocitinib 100 mg once a day, tofacitinib 5 mg twice a day, or cyclosporine 100 mg once a day from April 2024 to March 2025. Clinical assessments were analyzed at baseline and weeks 4, 8, 12, and 16 using Eczema Area and Severity Index (EASI), Scoring Atopic Dermatitis (SCORAD), and Dermatology Life Quality Index (DLQI). Serum IgE levels and adverse events (AEs) were also analyzed. RESULTS: Fifteen patients (five per group) were included as per the inclusion and exclusion criteria. At week 16, all three groups showed significant within-group improvements in EASI, SCORAD, DLQI, and Numerical Rating Scale (NRS) scores (p<0.001). However, compared with tofacitinib and cyclosporine, abrocitinib showed greater reduction in mean scores (EASI: 87% vs. 64% and 51%; SCORAD: 93% vs. 55% and 40%; NRS: 85% vs. 62% and 51%; all p<0.01), respectively. DLQI also demonstrated a similar trend in abrocitinib (80%) against tofacitinib (59%) and cyclosporine (47%) (p<0.01). A significant decrease was also observed for serum IgE level in the abrocitinib group. In the abrocitinib group, two patients had headaches and nausea each, whereas two patients reported infection in the tofacitinib group. In the cyclosporine group, two patients had hypertension. All AEs were mild and resolved over the study period, with no treatment discontinuations. There was no statistical difference between any of the groups. CONCLUSIONS: In our small sample-sized analysis, all treatment groups were found to be efficacious and safe. However, abrocitinib showed a better clinical response than the other two groups in achieving symptom control. However, due to the small sample size, these claims can't be generalized, and further large-scale studies are needed to validate these findings and assess long-term outcomes.

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