Parallel Inhibition of Interleukin 4 (IL-4)/Interleukin 13 (IL-13) and Janus Kinase 1 (JAK1) in Atopic Dermatitis - Beyond the Traditional Biologic Paradigm

Sep 29, 2026

Moderate-to-severe atopic dermatitis (AD) substantially impairs quality of life; beyond pruritus, cutaneous pain is clinically relevant. Although dupilumab and abrocitinib have transformed management, some patients fail to achieve sustained remission on monotherapy. In refractory cases, combining both agents may optimize control of pruritus and pain and enhance overall response. Three severe AD cases were treated successfully with dupilumab plus abrocitinib.

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Abstract

Introduction

Case Presentation

Patient 1

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Review began 11/13/2025 Review ended 11/28/2025 Published 12/06/2025 © Copyright 2025 Perez-Romero et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98589 Open Access Case Report Parallel Inhibition of Interleukin 4 (IL- 4)/Interleukin 13 (IL-13) and Janus Kinase 1 (JAK1) in Atopic Dermatitis: Beyond the Traditional Biologic Paradigm Ana G. Perez-Romero 1 , Martha A. Rangel 1 , Ana B. Crocker Sandoval 2, Mariana Ruiz Leon 1, Martha Aceves 1 1. Dermatology, Hospital Regional "Dr. Valentín Gómez Farías " Institute for Social Security and Services for State Workers (ISSSTE), Zapopan, MEX 2. Dermatology, Hospital San Javier, Guadalajara, MEX Corresponding author: Martha Aceves, [especialidad.derma.hrvgf@gmail.com](especialidad.derma.hrvgf@gmail.com) Abstract Moderate-to-severe atopic dermatitis (AD) substantially impairs quality of life; beyond pruritus, cutaneouspain is clinically relevant. Although dupilumab and abrocitinib have transformed management, a proportion of patients fail to achieve sustained remission on monotherapy. In refractory cases, combining both agents may optimize control of pruritus and pain and enhance overall response. We present three severe AD cases successfully treated with dupilumab plus abrocitinib. All three patients exhibited favorable changes inclinimetric scores, with prompt pruritus relief and a clinically stable course during follow-up. Dupilumab reduces pruritus and flares and significantly improves quality of life, yet a relevant proportion exhibits incomplete response or relapse. In this setting, abrocitinib, a selective Janus kinase 1 (JAK1) inhibitor, produces a rapid effect on pruritus and pain, thus providing a dual effect with rapid, durable control of pruritus and pain along with a significant improvement in quality of life in refractory severe AD, supporting its use in carefully selected patients under close clinical and laboratory monitoring. Categories: Quality Improvement, Allergy/Immunology, Dermatology Keywords: abrocitinib, atopic dermatitis, combination drug therapy, dupilumab, jak1 inhibitors Introduction Atopic dermatitis (AD) is a chronic inflammatory dermatosis that frequently presents in moderate-to-severe forms with substantial impairment of quality of life. While pruritus remains the hallmark symptom, cutaneous pain is increasingly recognized as a clinically meaningful component, particularly in severe disease [1,2] . Targeted therapies, such as dupilumab, which inhibits interleukin 4 (IL-4)/interleukin 13 (IL- 13) signaling via IL-4Rα blockade, and abrocitinib, a selective Janus kinase 1 (JAK1) inhibitor that modulates downstream signaling of multiple cytokines-have transformed care [1,3,4]. Nevertheless, a considerable proportion of patients fail to achieve durable clinical remission on monotherapy [2,5] . In refractory disease, concomitant use of both agents has emerged as a therapeutic alternative; this dual approach may enhance control of complex symptoms, including pruritus and pain, and improve overall treatment response in severe AD [2,6] . Herein, we present three cases of severe AD inadequately controlled with monotherapy and successfully managed with combined dupilumab and abrocitinib. The PROMs (Patient Reported Outcome Measures) and CROMs (Clinician Reported Outcome Measures) applied at baseline and at six months in each patient were EASI (Eczema Area and Severity Index) [7], POEM (Patient Oriented Eczema Measure) [8], worst pruritus NRS (numeric rating scale) [9], and worst pain NRS [10]. Case Presentation Patient 1 Patient 1 is a 16-year-old girl with a history of infantile eczema and diaper dermatitis that progressed to AD during the first year of life, with comorbid allergic rhinitis and co

FAQs

Why was combination therapy considered for refractory atopic dermatitis?

Some patients do not achieve durable remission on single-agent therapy. Combining dupilumab with abrocitinib is presented as a way to better control complex symptoms, including pruritus and pain.

What outcomes were tracked during the follow-up?

Clinimetric and PROM/CROM measures included EASI, POEM, worst pruritus NRS, and worst pain NRS at baseline and at six months, with clinical follow-up reported for each case.

How did Patient 1 respond when therapy was adjusted?

After an initial improvement with dupilumab plus cyclosporine, Patient 1 experienced a severe flare. Cyclosporine was stopped and abrocitinib was added with dupilumab, leading to progressive pain reduction and sustained disease control over nine months.

Sep 29, 2026

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