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Background: The heterogeneous course of moderate-to-severe atopic dermatitis necessitates treatment flexibility.Objective: We evaluated the maintenance of abrocitinib-induced response with continuous abrocitinib treatment, dose reduction or withdrawal, and response to treatment reintroduction following flare (JAK1 Atopic Dermatitis Efficacy and Safety [JADE] REGIMEN: National Clinical Trial 03627767).Methods: Patients with moderate-to-severe atopic dermatitis responding to open-label abrocitinib 200 mg monotherapy for 12 weeks were randomly assigned in a 1:1:1 ratio to blinded abrocitinib (200 or 100 mg) or placebo for 40 weeks. Patients experiencing flare received rescue treatment (abrocitinib 200 mg plus topical therapy).Results: Of 1233 patients, 798 responders to induction (64.7%) were randomly assigned. The flare probability during maintenance was 18.9%, 42.6%, and 80.9% with abrocitinib 200 mg, abrocitinib 100 mg, and placebo, respectively. Among patients with flare in the abrocitinib 200 mg, abrocitinib 100 mg, and placebo groups, 36.6%, 58.8%, and 81.6% regained investigator global assessment 0/1 response, respectively, and 55.0%, 74.5%, and 91.8% regained eczema area and severity index response, respectively, with rescue treatment. During maintenance, 63.2% and 54.0% of patients receiving abrocitinib 200 and 100 mg, respectively, experienced adverse events.Limitations: The definition of protocol-defined flare was not established, limiting the generalizability of findings.

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Tofacitinib is a selective 1/3 janus kinase inhibitor (JAKi), used to treat a number of inflammatory diseases including rheumatoid arthritis, psoriatic arthritis, psoriasis, atopic dermatitis, systemic lupus, sarcoidosis, vitiligo, and alopecia areata (AA). 1,2 Tofacitinib inhibits signaling of numerous cytokines including interferon (IFN)-γ, interleukin (IL)-2, IL-4, IL-7, IL-9, IL-15, and IL-21, thereby attenuating the inflammatory cascade and activation of T cells involved in AA pathogenesis. 3,4 Alopecia areata is an autoimmune, non-scaring alopecia with an estimated lifetime prevalence of 2%. 5 Almost half of all patients experience disease onset within the first two decades of life making it the most common cause of hair loss in children. 6 The natural history of