Alternative Medications to Dupilumab for Atopic Dermatitis

First-Line Alternative: Tralokinumab

The American Academy of Dermatology recommends tralokinumab as the first-line alternative to dupilumab for moderate-to-severe atopic dermatitis, with a strong recommendation and moderate certainty of evidence 1
Tralokinumab has a similar efficacy profile to dupilumab but with potentially fewer side effects for certain patients 1

The American Academy of Dermatology recommends upadacitinib and abrocitinib as second-line alternatives to dupilumab, with a strong recommendation and moderate certainty of evidence 1, 2
Upadacitinib is a selective JAK-1 inhibitor available in 15mg or 30mg daily oral dosing, with higher efficacy at reducing EASI scores compared to dupilumab in head-to-head trials 1, 2
Abrocitinib is a selective JAK-1 inhibitor available in 100mg or 200mg daily oral dosing, with demonstrated superior efficacy to dupilumab in head-to-head trials 1, 2

The American Academy of Dermatology conditionally recommends phototherapy for adults with atopic dermatitis, with a conditional recommendation and low certainty of evidence 1
Baricitinib is a JAK-1 and JAK-2 inhibitor approved in Europe but not FDA-approved for atopic dermatitis in the US, with less efficacy than upadacitinib and abrocitinib based on network meta-analysis 2

The FDA warns of increased risk of serious cardiovascular events, cancer, blood clots, and death with JAK inhibitors, and recommends baseline laboratory testing and regular monitoring 2

For patients with dupilumab-related ocular surface disorders, switching to JAK inhibitors like abrocitinib may resolve eye symptoms 4
For females planning pregnancy, tralokinumab may be preferred over JAK inhibitors 3

Regular assessment of treatment efficacy and adverse effects is recommended for all alternatives 1, 2