Watch as James Q. Del Rosso, DO, shares insights on tralokinumab’s role in achieving disease control after dupilumab and JAK inhibitor failure

In this video, James Del Rosso, DO, reviews a Fall Clinical 2025 poster presentation that highlights a real-world case demonstrating successful disease control with tralokinumab in a patient whose severe atopic dermatitis (AD) was refractory to multiple prior systemic therapies.

Clinical case overview

The case involved a 29-year-old male with long-standing AD, a history of recurrent skin infections, asthma, allergies, and a recent episode of pneumonia. 

The patient initiated dupilumab but experienced an inconsistent response and ocular adverse effects (conjunctivitis and blepharitis). Two Janus kinase (JAK) inhibitors were later trialed (upadacitinib for 4 months, abrocitinib for 3 months) and achieved only partial efficacy complicated by acneiform eruptions.

Response to tralokinumab

The patient transitioned to tralokinumab while presenting with Investigator’s Global Assessment (IGA) 4 disease severity. After one year of treatment, he achieved complete clearance (IGA 0), with marked improvement in itch and quality of life.

Dr Del Rosso notes that while treatment trajectories in AD vary widely, this case demonstrates the value of mechanistic diversity within available biologics. For this patient, tralokinumab provided both clinical efficacy and relief from the adverse events that limited previous therapies.

Supporting evidence in the literature

Additional reports reinforce these findings. A 2023 publication in the Journal of Dermatological Treatment described a patient with dupilumab-associated facial and neck erythema and subsequent lichenification while on upadacitinib. Transitioning to tralokinumab led to rapid improvement in erythema and overall AD control.

Likewise, a 2025 case series in the Journal of Clinical and Aesthetic Dermatology presented 15 adult cases of arthropathies and arthralgias arising during dupilumab therapy (duration 1–48 months). Upon switching to tralokinumab, all patients maintained disease control without recurrence or persistence of joint symptoms.

Takeaway for clinicians

Dr Del Rosso notes that these cases highlight the progressive diversification of therapeutic mechanisms in AD. For patients with suboptimal response or adverse effects on prior biologics or JAK inhibitors, switching to another targeted agent, in this case, tralokinumab, may achieve durable control without compromising tolerability.