Experience with the use of the janus-kinase inhibitor (upadacitinib) off-label in a 8-year-old patient with severe atopic dermatitis that is torpid to classical therapy

Abstract

Introduction. Atopic dermatitis (AtD) is one of the most common skin diseases in the world and its frequency is increasing. This is one of the few diseases that debuts in infancy, and can persist throughout life, worsening its quality, and sometimes leading to disability. Therefore, the treatment of atopic dermatitis remains an urgent problem in allergology and pediatrics in general. Traditionally, the treatment of atopic dermatitis is based on elimination measures and local anti-inflammatory therapy for skin exacerbations, but often such a complex is insufficient to relieve the symptoms of the disease, which leads to the need to use targeted therapy with monoclinal antibodies, including in some cases upadacitinib.
Description of the clinical case. This publication presents our own successful experience of using upadacitinib in the form of a description of a clinical case in an 8-year-old patient with uncontrolled severe AtD. Before the drug was prescribed, the patient’s disease course was continuous, with severe exacerbations and no remission, as well as resistance to the recommended therapy at this age, including targeted therapy (Dupilumab, Omalizumab).Conclusion. In our opinion, the appointment of upadacitinib outside the age limits of the instructions may be justified in the most severe cases of atopic dermatitis, torpid to traditional therapy and other targeted drugs, since it carries fewer risks of side effects than the use of systemic glucocorticosteroids and cytostatics, but requires a consultation in an appropriate institution.