From the Guidelines
Shifting to Tralokinumab is not a viable option for a patient with autoimmune hypothyroidism and dyslipidemia who failed to respond to Dupixent (Dupilumab) and was subsequently controlled on Upadacitinib, as Tralokinumab also targets the IL-13 pathway and has been associated with an increased risk of ocular surface disease 1.
Key Considerations
- The patient's history of failing to respond to Dupilumab, which also targets the IL-4/IL-13 pathway, suggests that alternative therapies should be considered to minimize the risk of ocular adverse effects.
- Upadacitinib, a Janus kinase inhibitor, has been effective in controlling the patient's condition, and switching to Tralokinumab may not provide additional benefits while introducing a new risk of ocular surface disease.
- The patient's underlying conditions, including autoimmune hypothyroidism and dyslipidemia, should be carefully managed with Lipitor (Atorvastatin) and other necessary medications.
Management Recommendations
- Continue Upadacitinib as it has been effective in controlling the patient's condition.
- Monitor the patient's ocular health closely, as they have a history of failing to respond to Dupilumab, which is associated with an increased risk of ocular surface disease.
- Consider alternative therapies that do not target the IL-4/IL-13 pathway, such as monoclonal antibodies targeting type 2 pathways other than IL-4/IL-13, including IL-31, which do not have the same pattern of ocular adverse effects 1.
From the Research
Management of Autoimmune Hypothyroidism and Dyslipidemia
- The patient's condition involves autoimmune hypothyroidism and dyslipidemia, and they are already on Lipitor (Atorvastatin) for dyslipidemia management.
- The patient failed to respond to Dupixent (Dupilumab) but was subsequently controlled on Upadacitinib.
Switching to Tralokinumab
- There is limited direct evidence on switching from Upadacitinib to Tralokinumab in patients with autoimmune hypothyroidism and dyslipidemia.
- However, studies have compared the efficacy of Tralokinumab with other treatments for atopic dermatitis, such as Dupilumab and Janus kinase inhibitors like Upadacitinib 2.
- A systematic review and meta-analysis found that Tralokinumab, Dupilumab, and Janus kinase inhibitors all had an acceptable efficacy profile for moderate-to-severe atopic dermatitis, with Upadacitinib showing high efficacy in monotherapy studies 2.
- Another study found that Upadacitinib was effective in patients with atopic dermatitis, including those with inadequate response to Dupilumab and/or Baricitinib, with comparable effectiveness in patients with and without prior treatment with these medications 3.
Considerations for Switching
- When considering switching from Upadacitinib to Tralokinumab, it is essential to weigh the potential benefits and risks, including the patient's response to previous treatments and their individual disease characteristics.
- Studies have shown that switching from Dupilumab to Upadacitinib can lead to improved outcomes in patients with atopic dermatitis, with no new safety risks observed 4, 5.
- However, the safety and efficacy of switching from Upadacitinib to Tralokinumab specifically are not well-established, and more research is needed to determine the best approach for individual patients 2.