Efficacy, Safety, and Patterns of Switching Among Advanced Therapies in Patients With Difficult-to-Treat Atopic Dermatitis

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Background: Atopic dermatitis (AD) is a heterogeneous chronic inflammatory disease characterized by variable responses to multiple therapeutic options.In patients with difficult-to-treat AD, switching between advanced therapies has emerged as a practical strategy in rputine clinical practice.Objective: This study aimed to investigate real-world switching patterns and evaluate the clinical efficacy and safety of alternative advanced therapies in patients with severe AD requiring treatment switching.Methods: This single-center retrospective study included patients aged ≥12 years with severe AD who underwent switching between advanced therapies at Chosun University Hospital between January 2021 and September 2025.Advanced therapies included biologics (dupilumab and tralokinumab) and Janus kinase inhibitors (upadacitinib, abrocitinib, and baricitinib).Clinical efficacy, laboratory biomarkers, and treatment-emergent adverse events (TEAEs) were assessed.Results: A total of 36 patients were included.Dupilumab was the most common first-line therapy, and switching most frequently occurred from dupilumab to upadacitinib.After the first switch, all AD control tools significantly improved at week 12 or 16.Eczema Area and Severity Index (EASI)-75 and EASI-90 were achieved in 86.1% and 16.7%, respectively.Peripheral blood eosinophil counts significantly decreased, whereas other laboratory biomarkers showed no significant changes.TEAEs were less frequent during second-line therapy, and most adverse events improved after switching.Conclusion: In this real-world cohort of patients with severe difficult-to-treat AD, switching between advanced therapies was associated with improved clinical outcomes and an acceptable safety profile.Switching between therapies with different mechanisms of action may provide additional clinical benefit for patients with inadequate response to initial treatment.

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