Real-life Case-series Experience with Tralokinumab in Patients with Severe Atopic Dermatitis: When to Consider Tralokinumab?

Atopic dermatitis (AD) is a chronic inflammatory skin condition driven largely by type-2 immune responses, particularly interleukin-13 (IL-13). Tralokinumab, a monoclonal antibody targeting IL-13, has emerged as a novel biologic therapy for moderate-to-severe AD. While clinical trials have demonstrated its efficacy and safety, real-world experience remains limited. This case series presents 10 Saudi adult patients, 7 of them were males and 3 females, all patients had severe AD managed with tralokinumab in a tertiary dermatology clinic. Patients received a tralokinumab as a subcutaneous injection at an initial dose of 600 mg (four 150 mg injections), followed by 300 mg (two 150 mg injections) administered every other week. Severity was assessed using the Eczema Area and Severity Index (EASI) and Numerical Rating Scale (NRS) for itch at baseline and 16 weeks. 9 out of 10 patients completed 16 weeks of treatment and showed significant clinical improvement, with marked reductions in EASI and NRS scores. One patient discontinued at week 4 due to lack of improvement. No serious adverse events were reported, though one patient experienced a mild injection site reaction. Patients with previous biologic failure, including dupilumab, and those with head and neck involvement responded favorably. Tralokinumab demonstrated excellent efficacy and a favorable safety profile in patients with moderate-to-severe AD. Tralokinumab can be effective in patients unresponsive to other systemic treatments, including dupilumab and upadacitinib, with a good tolerability profile.