TRALOKINUMAB improved disease control for many adults with moderate to severe atopic dermatitis after dupilumab failure.
Tralokinumab for Dupilumab Nonresponders in Practice
In this retrospective review from NYU Langone Health, investigators evaluated 49 patients prescribed tralokinumab between January 2019 and January 2024. Most had long standing, moderate-to-severe atopic dermatitis and 96% had previously received dupilumab. Eligible patients had at least two tralokinumab prescriptions and follow up data for body surface area, peak pruritus numeric rating scale or Investigator Global Assessment, together with patient reported symptoms.
Overall, 51% of prior dupilumab users experienced clinical improvement on tralokinumab based on objective scores or patient reported benefit. Median dupilumab exposure before switching was 333 days, indicating that many patients had a substantial trial of their initial biologic before being considered nonresponders or intolerant.
Clinical Response and Symptom Relief
Among patients with evaluable data, tralokinumab treatment led to significant reductions in mean body surface area involvement from 20.5% to 11.4% within three months. Peak pruritus numeric rating scale scores also fell from 6.2 to 4.2 over the same period, with both changes reaching statistical significance. Mean Investigator Global Assessment scores decreased from 2.60 to 2.19 although this trend did not reach significance and 14% of patients achieved an Investigator Global Assessment of one or lower.
Patients also reported meaningful shifts in day-to-day disease burden. One-third reduced their use of topical therapies and nearly half described fewer disease flares while receiving tralokinumab. For a subset who discontinued dupilumab because of side effects, transition to tralokinumab was associated with resolution of conjunctivitis or head and neck dermatitis. A small number developed conjunctivitis on tralokinumab and two of these individuals had experienced the same adverse event on dupilumab, which supports the need for continued monitoring.
Implications for Biologic Sequencing in Atopic Dermatitis
These real-world findings suggest that tralokinumab for dupilumab nonresponders can provide additional disease control and symptom relief in moderate to severe atopic dermatitis. For dermatologists managing patients with inadequate response or intolerance to their first biologic, tralokinumab offers an alternative strategy targeting the same Th2 pathway through selective interleukin 13 blockade. Larger prospective studies will be important to refine patient selection and clarify long term outcomes while this cohort supports tralokinumab as a viable next step in complex atopic dermatitis care.
Reference: Olagun-Samuel CT. Tralokinumab for moderate-to-severe atopic dermatitis: A viable option for dupilumab nonresponders. JAAD International. 2026;24:67-69.
