Treatment Trajectories and Dose Optimization of Abrocitinib in Moderate-to-Severe Atopic Dermatitis: A Real-World Landmark Analysis

BACKGROUND: Abrocitinib is an effective oral Janus kinase 1 inhibitor for moderate-to-severe atopic dermatitis (AD), although real-world evidence regarding dose optimization strategies remains limited. OBJECTIVES: To evaluate treatment trajectories and short-term clinical outcomes associated with abrocitinib dose maintenance, escalation, and step-down in routine clinical practice. METHODS: A retrospective single-center observational study was conducted including adult patients with moderate-to-severe AD treated with abrocitinib. A Week 16 (W16) landmark approach was used to classify patients into four treatment trajectories: maintenance of 200 mg, step-down from 200 mg to 100 mg, maintenance of 100 mg, and escalation from 100 mg to 200 mg. Clinical outcomes, including Eczema Area and Severity Index (EASI), pruritus Numerical Rating Scale (p-NRS), and Dermatology Life Quality Index (DLQI), were evaluated at W16 and W24. RESULTS: Among 58 patients included in the landmark analysis, 37 (63.8%) initiated abrocitinib 200 mg and 21 (36.2%) initiated 100 mg. Most patients maintained their starting dose through W16 (83.8% in the 200-mg group and 76.2% in the 100-mg group). Dose escalation from 100 mg to 200 mg occurred in 23.8% of patients and was exclusively driven by insufficient efficacy, whereas step-down from 200 mg to 100 mg occurred in 10.8% and was related to treatment-emergent tolerability concerns or clinical improvement. Clinically meaningful reductions in EASI, p-NRS, and DLQI were observed across all trajectory groups, without significant differences in W24 outcomes. CONCLUSIONS: In routine clinical practice, most patients maintained their initial abrocitinib dose, while dose optimization strategies appeared feasible in selected cases without compromising short-term disease control.