In two double-blind randomised trials, abrocitinib at a dose of 200 mg per day appeared effective in slightly more patients than dupilumab during the first weeks of treatment (an approximately 10 percentage-point increase in the proportion of "responders")/ but not at a dose of 100 mg per day. This modest increase in response rate must be weighed against the approximately 15 percentage-point increase in the proportion of patients who experienced adverse effects with abrocitinib 200 mg compared with dupilumab. For adults with very troublesome atopic eczema (also called atopic dermatitis), when a systemic immunosuppressant seems justified, ciclosporin is often the first choice, despite its limitations. If ciclosporin is insufficiently effective or its adverse effects are too troublesome, dupilumab, an immunosuppressant that inhibits interleukin-4 and interleukin-13 receptors, is an option. Immunosuppressants that inhibit Janus kinases (JAKs) have also been authorised for use in atopic eczema (see "Upadaci-tinib in atopic eczema" p. 93).
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