Real-World Tralokinumab Use in Dupilumab-Experienced Patients: A Eetrospective Multi-Center Case Series

Abstract

Introduction: There is a need for treatment options that offer atopic dermatitis (AD) patients long-term disease control along with a favorable safety profile. Head-to-head studies of the two available FDA-approved biologics dupilumab and tralokinumab for adults with moderate-to-severe AD have not been performed, and real-world evidence of tralokinumab use in patients that were previously treated with dupilumab is limited.
 Objective: To further characterize the tralokinumab efficacy and safety profile by evaluating clinical findings in patients previously treated with dupilumab in routine clinical practice who later switched to tralokinumab.
 Method: Nine adult patients with moderate-to-severe AD previously treated with dupliumab, and subsequently switched to tralokinumab, were included. Data collected during routine clinical practice related to tralokinumab treatment included duration of treatment, dose, IGA, BSA, PROs, and AEs.
 Results: Median (range) baseline IGA and IGA at time of tralokinumab administration were 4 (3-4) and 3 (2-4), respectively. Median baseline BSA and BSA at time of tralokinumab administration were 20% (4-30%) and 10% (1-30%), respectively. Disease duration ranged from 1-2 years to over 20 years. Duration of dupilumab treatment was 2-8 months (n=6). Reasons for discontinuing dupilumab treatment included AEs (n=5) and inadequately controlled AD on dupilumab (n=3). All 9 dupilumab-experienced patients were administered on-label tralokinumab (every 2 weeks, n=1; every 4 weeks, n=1) and had been on tralokinumab for 2-8 months. At the time of data collection, median (range) IGA and BSA for these patients were 0 (0-3) and 0% (0-10%), respectively. All patients experienced improvements in PROs; 67% (6/9) reported improvements in itch with NRS scores of 0/1, 44% (4/9) reported general clearance of AD signs and symptoms, and 44% (4/9) reported overall satisfaction of being on tralokinumab. AEs of conjunctivitis (n=3) and joint pain (n=1) completely resolved in patients upon switching from dupilumab to tralokinumab. No AEs were reported except in 1 patient with possible mild seborrheic dermatitis/head-neck dermatitis eruption that was treated with topicals, and 1 patient with herpes labialis, which was unclear if related to tralokinumab treatment.
 Conclusion: This case series suggests tralokinumab is a potentially effective therapy in moderate-to-severe AD patients who have failed dupilumab due to lack of efficacy or AEs.